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Concept of Realist methodology

Realism

: Realism is a scientific epistemology (position of a community of researchers addressing the philosophical aspects of the scientific question: How do we know what we know? that is said to be realistic  about evidence gathering, given the limits of human capacity in garnering the truth of phenomena throughobservation, perception, and interpretation (Sayer, 2000). The philosophy of realism ponders on the fallibilityof knowledge, bringing attention to the limits of both logical empiricism (e.g., as it manifests in the logic of randomized controlled trials and reviews of such) and constructivism as approaches to knowledge synthesis.Realism would suggest that one limitation of empiricism is that it sets aside important causal explanations if they are not immediately linked to observable evidence. On the other hand, constructivism, whichemphasizes explanatory theories and mainly in terms of human or cultural interpretation, does not pursuean objective assessment of evidence that is deemed (by realism) to be foundational to a comprehensiveunderstanding of causality. Realist modes of research reflect a mix of these two epistemologies by posingthe kinds of questions that seek out the truth of matters, while at the same time operating from a view of the historically, socially, and linguistically contingent nature of human knowledge.

Realist Methodology or Realist review (RR)

: RR is an approach to synthesizing quantitative, qualitative, or mixed methods research,based on a realist logic of enquiry. It answers questions of the general format

 what worked, for whom andin what circumstances, how and why?

Initially designed to assess social policy, programs, and interventions,RR originated from a perceived inadequacy of usual empirical methods for evaluating social programs(Pawson, 2006b). Pawson is critique of empiricism brings into question the applicability of empirical methodsto assess causality (i.e., assessment of cause and effect) for social phenomena found in open systems. Insystematic reviews of randomized controlled trials, for example, causality is investigated by counting therepeated occurrence of cause and effect across a number of cases. In contrast, realists point out the causal mechanisms (Astbury and Leeuw, 2010) involved in investigated phenomena. Realists argue that searchingfor causal mechanisms is more appropriate for investigating social phenomena in open systems (e.g., healthprograms in community-based settings) than for investigating material phenomena in controlled trials (e.g.,pharmaceutical testing), because the former are open to an infinite array of in fluences that impactoutcomes, whereas the latter have been placed in studies designed to control extraneous and unknown influences and to account for effects of known, interjected in fluences.

Complex intervention

: A complex intervention can be understood as a program (often multiple interacting component interventions that offers resources or information, or enforces actions upon a targetgroup (e.g., a population sample) and is built on implicit or explicit logic that such efforts will lead topositive change in or for that group. Complexity arises from the following: (a) the volitions of the targetgroup; (b) their implementation in local (community or institutional) settings, which bring an array of uncontrollable contextual variables that exercise an impact on outcomes in addition to the interventionitself; and (c) emergent phenomena, where an outcome might change the underlying context and producefeedback that alters the prior implementation.

Middle-range theory (MRT)

: MRT is an implicit or explicit explanatory theory that can be used to explain specific parts of programs and interventions. Middle-range means that it can be tested with the observable data and isnot abstract to the point of addressing larger social or cultural forces (i.e., grand theories) (Merton, 1967). MRT issought throughout the review and may initially help to shape the review protocols.

Context, mechanism, and outcome (CMO) configurations : CMO configuring is a heuristic used to generatecausative explanations pertaining to outcomes in the observed data. The process draws out and reflects onthe relationship of context, mechanism, and outcome of interest in a particular program. A CMOconfiguration may pertain either to the whole program or only to certain aspects. One CMO may beembedded in another or configured in a series (in which the outcome of one CMO becomes the context forthe next in the chain of implementation steps). Configuring CMOs is a basis for generating and/or refiningthe theory that becomes the final product of the review. A simple example of a CMO configuration is asfollows: A community experiences a high level of unemployment to which an employment training programis offered in a remote part of town (context). But the program has low enrollment and high attrition, andfew people are trained (outcome). The reason is that people feel disillusioned by the lack of effort byprogram planners to ensure adequate public transportation to the venue (mechanism).

Context 

: Context often pertains to the backdrop of programs and research. For example, in our review of participatory research, it pertains to the conditions connected to the development of research partnerships. Asthese conditions change over time, the context may reflect aspects of those changes while the program isimplemented. Examples of context include cultural norms and history of the community in which a program isimplemented, the nature and scope of existing social networks, or built program infrastructure. They can also betrust-building processes, geographic location (e.g., rural or urban), types of funding sources, and otheropportunities or constraints. Context can be broadly understood as any condition that triggers and/or modifies the mechanism.

Mechanism

: A mechanism is the generative force that leads to outcomes. It often but not always denotes thereasoning (cognitive or emotional) of the various actors in relation to the work, challenges, and successes of thepartnership. Mechanisms are linked to, but not synonymous with, the programs strategies (e.g., a strategy maybe an intended plan of action, whereas a mechanism involves the participants  reaction or response to theintentional offer of incentives or resources). Identifying the mechanisms advances the synthesis beyonddescribing what happened to theorizing why it happened, for whom, and under what circumstances

Outcomes

: Outcomes are either intended or unintended and can be proximal, intermediate, or final. Examplesof PR outcomes from our review include the following: increased self-empowerment, participant enrolment,higher education opportunities, acquisition of skills and knowledge, development of program infrastructure,and enriched research processes. Examples of intervention outcomes are improved health status, increaseduse of health services, and enhanced research results.

Demi-regularity 

: Demi-regularity means semipredictable patterns or pathways of program functioning. The termwas coined by Lawson (1997), who argued that human choice or agency manifests in a semipredictable manner semi because variations in patterns of behavior can be attributed partly to contextual differences from onesetting to another.

 Abductive process

: This concept means inference to the best explanation It involves an iterative process of examining evidence and developing hunches or ideas about the causal factors linked to that evidence

ที่มา Jagosh, J., Pluye, P., Wong, G., Cargo, M., Salsberg, J., Bush, P. L., Herbert, C. P., Green, L. W., Greenhalgh, T., & Macaulay, A. C. (2014). Critical reflections on realist review: insights from customizing the methodology to the needs of participatory research assessment. Research synthesis methods5(2), 131–141. https://doi.org/10.1002/jrsm.1099

Your Growing Child

 

Fostering Imagination and Balance

Music triangle boy and girl.jpgA mother wrote to Rahima: I have read books (You are Your Child’s First Teacher, and lots of Steiner) and listened to two audiotapes from this site on parenting the young child in the first 7 years of life. I became more conscious of changing the way I parented my son when he was about 3.5 years old. He is now 6.5. In general, I take a loving authoritative approach, I don’t offer a lot of choices, and feel confident steering the boat.
My problem is engaging him in discussions. Despite knowing what I ought to do when we come into conflict, I cannot seem to STOP speaking to him with concepts and engaging him in discussions, explaining, talking it out, etc. (It was how I was raised and so much a part of me, and I was precocious, “such a mature young girl”).

It seems like half the time I do address him appropriately and half the time I react through the intellect. Lately, I can see how much he is like me and getting the comments from others like, “He is so verbal. So smart. So mature.” While some might think this is desirable, I know what I am depriving him of by having instilled this in him through all the conversations we have.
I really need help in learning ways to re-program my impulses to hold discussions (not just about talking about feelings, but talking about everything!). And more importantly I am interested in knowing what I can do from this point out as he is entering the second phase of childhood. Is it too late? Your help is greatly appreciated. –H.C.

Rahima writes: Old habits die hard, and since you have success about half the time, I’m not sure there is anything else you can do–besides not be so hard on yourself. Your son probably has good genes and is naturally bright and awake. You both can’t cause that and can’t avoid it. So pat yourself on the back for not taking that up and running with it, as many parents with bright/gifted children do.

What else can you do as he comes out of the first phase of childhood? Continue to value balance, and give him as large a dose of the arts as you can. This is one of the things the Waldorf approach is very good at, teaching everything artistically between 7 and 14. If you aren’t near a Waldorf school, then this would involve bringing as many of the arts to him as you can through after-school enrichment and/or home schooling using a Waldorf approach. Our DVD on Creating a Waldorf Enrichment Program might give you some good ideas. You can start now, letting him do the wet-on-wet watercolor painting and Coloring with Block Crayons.

Be sure to keep providing many opportunities for creative play–both inside and outdoors–rather than filling up his life with lessons as he gets older. Read Simplicity Parenting–it’s the book that takes up where mine leaves off.

At six-and-a-half you can also bring your son a rich serving of fairy tales. Buy a copy of The Complete Grimm’s Fairy Tales (not the “as told by,” watered down versions) and read through one of the more complex ones to make sure that it resonates with you–if you react against that one, choose another. You don’t have to memorize it– it’s okay to read it to him–but I would read him the same story every night for a week so it really has a chance to go into his sleep and dream life. Maybe make Sundays the night you change stories so there will be a rhythm and he’ll know what to expect.

There are also two books about children’s stories and books that supplement Steiner’s understanding of child development, Make Way for Reading and Books for the Journey, both available from Michaelmas Press.

Those suggestions should give you enough to start with and will not only enrich your child’s life, but yours as well.

Children, Birth and Sex Education

Pregnant, w toddler.jpgby Rahima Baldwin Dancy
Where do babies come from? What do children need to know in terms of “sex education,” and when? What about when a new baby is going to be born at home?

Young children today are usually quite aware that a baby is growing “inside mommy’s tummy,” and they will sometimes give kisses to the baby or tell you something about him or her during the months of pregnancy. But how did the baby get there, and what will help prepare them for the birth?

Regardless of the question, young children are not asking about the mechanics or even the physical realities–which is why they are usually satisfied with an answer that emphasizes the spiritual realities. If you are telling them the truth, it doesn’t have to be the whole truth and can be augmented as they grow and become “more earthly.” The very young child has just come from the spiritual world and still has one foot there, which is why talking about a little angel or Star Child coming to earth to be their brother or sister makes sense to them–they were recently in that state themselves and are still strongly in touch with their own spiritual reality.

So–if this applies to your family situation–you might say something like, “When you were a Star Child up in heaven, you saw how much your daddy and I loved each other and how much we would love you, too, and you decided to come down and be part of our family. And our new baby saw this, too, and also wanted to have you as big brother (or sister).” Some children’s books that reinforce this understanding include Little Angel’s Journey by Dzvinka Hayda (available on Amazon). This book retells the Waldorf birthday story of the child coming to birth over the rainbow bridge. Birthdayby Heather Jarman tells the story of young children, on their birthday, waiting to travel with Father Time from heaven down to earth (from Steiner Books). And, if you don’t know On the Night You Were Born by Nancy Tillman, it’s a real delight (from Amazon).

Here are some other suggestions: “The baby is growing, getting bigger and bigger, and when the leaves are turning colors this fall, it will be time for her to come out and join our family.” “Mommy has a special place between her legs that opens up for the baby to come out and closes back up again. When the baby and mommy will be working together so he or she can come out, it’s called ‘labor,’ which means ‘hard work.’ So mommy might be making noises then, like moving a piano. That’s how hard she’ll be working” (then you could make grunting noises together).

Having been a midwife for many years, I’ve seen many children participate in birth to varying degrees, from going over to grandmas, to wanting to be present every moment, to just missing the birth by a few minutes. It’s important that the parents decide to what extent they want their young child or children to participate and, if so, that they have someone who can take his or her cues from the child, leaving both parents free to focus on this unique labor and birth. My own thoughts at this point are that birth is really intense and, just as a couple wouldn’t have intercourse in front of their child due to the intimate and intense nature of the energy, I would think twice before having a young child present for the actual birth. Having said that, however, I would add that I have never seen a child upset by birth–they tend to be self regulating if someone is sensitive to their needs. However, young children don’t need to be present for the actual “coming out” to take in the message that birth is a normal part of life and is happening with everyone’s love and blessing. Coming in shortly after the birth (or even in the morning), can be plenty soon enough to meet the new baby and participate in the loving atmosphere.

In thinking about having children at birth, the first consideration is that the mother feel comfortable and able to concentrate on the work at hand without having to divide her attention or be afraid of ignoring or frightening a young child. If she feels she can do this with children in the house, then the second most important thing is that there is someone to be with the other child or children who is there only for them and who is willing to miss the actual birth, because young children often arrange to be away at the park or asleep at night when the baby actually comes out.

When I took the Waldorf teacher training, the teachers (mostly from the UK, Germany and Austria), talked about the story/image of babies being brought by the stork and how this was an image of the spiritual, not the physical reality–nobody was trying to say it was “literal,” the more so because children in earlier times were probably even more familiar with birth and farm life. Neither was it a “cute story” or a con for the children; rather, it was a “true image” in describing the spirit of the child coming to earth, accompanied by a white bird like the dove representing the Holy Spirit in the New Testament.

The spiritual realities about birth, combined with a few simple sentences about how the baby comes out are almost always enough for the young child. As the child matures, more information obviously needs to be given. Human Fertility, a guide for teachers (and parents) by Waldorf teacher Linda Knodle contains lesson plans to use in grades 4-7. Her sequel, Lessons for Middle School Issues, is for use with children in grades 8 and 9. She has also written a Rites of Passage Workbook, and all are available from her website, www.lindaknodle.com. We offer a CD or MP3 of Linda’s talk “Navigating the Terrain of Sexuality.”

Another internationally known writer and teacher, DeAnna L’am, is also a Waldorf parent and has written Becoming Peers for mothers and other women who care about girls’ coming of age. A lot of DeAnna’s work with women involves helping them release their own confusion and pain around menstruation and fertility so they can be clear guides for girls’ becoming women–so it’s never too early to start. We off her book and a CD/MP3 of hers, “Mentoring Youth into Adulthood“; or see her website at www.deannalam.com.

One remaining question is how and when to teach young children about boundaries and body integrity–please note that I use those words instead of “sex education” and “stranger danger”–since most cases of sexual abuse or even abduction involve people well known to the child. Unfortunately, I haven’t found any resources developed from a Waldorf understanding, and much of what is available is far too hysterical, burdening the child with unrealistic expectations. One of the guidelines I do like is from Blue Sky Bridge in Colorado, “Some Simple Tips to Help Keep Your Children Safe from Sexual Abuse.” Their sensible suggestions include listening to your child and maintaining a “secrets-free” home; and teaching your children that each person is in charge of their own body and no one is allowed to touch their body or make them touch another person’s body. Read the complete list here.

Better to Delay School Entry

Thumbnail image for our new play loft.JPGSchool should be delayed until age six because an over-emphasis on the three-Rs at an early age can cause significant long-term damage to bright children, according to Dr. Richard House, a senior lecturer at Roehampton University’s Research Centre for Therapeutic Education in England. He quoted a major US study – carried out over eight decades – that showed children’s “run-away intellect” actually benefited from being slowed down in the early years, allowing them to develop naturally. Pupils should not be subjected to full classroom tuition until the age of six to off-set the effects of premature “adultification,” and gifted pupils from relatively affluent backgrounds suffered the most from being pushed “too far, too fast” it was claimed.

House claimed the case for change was supported by a longitudinal study of gifted children who started in school in the US in the 1920s. Prof Howard Friedman, a psychologist at the University of California, analysed their progress over 80 years and found that “early school entry was associated with less educational attainment, worse midlife adjustment and, most importantly, increased mortality risk”.

House went on to develop the importance of play-based early learning through age six, which is supported by Waldorf education (the picture, above, is of the new play loft from the LifeWays Childcare Society in Vancouver). Steiner was very clear about the later health problems that can be associated with early academics and “adultification”–it’s interesting to see that supported by more mainstream work. Here is a link to the article.

Embryology and “Unbornness”

1013KA.jpgAs a midwife I’ve always been interested in fetal development and fascinated by Rudolf Steiner’s insights on both embryology and what he calls “pre-earthly existence.” In the book Unbornness, Peter Selg, MD, assembles many of Steiner’s insights on what each human being goes through prior to becoming the newborn we see and celebrate. One of the insights he shares about fetal development concerns the special role of the placenta, which Steiner observed is connected to “the higher members of the human being and is related to its cosmic-spiritual orientation and origin.”

Selg states that ancient wisdom knew of the cosmic origin of the human being, of our “unbornness,” which precedes the transition into the earthly community. This is why in ancient cultures the placenta was buried with a special ritual “as an essential aspect of human beings, of our origin and cosmic life before birth.”

I’m also half way through watching DVDs of a 4-day workshop by Jaap van der Wal, PhD, MD, called “Embryo in Motion. Understanding Ourselves as Embryo.” He is an anthroposophic physician, embryologist and professor from Holland, and the 4-DVD set is available from the Portland, Oregon branch of the Anthroposophical Society of America (www.portlandbranch.org).

Learning through Imitation

Finger play.jpg[This articles was written by Rahima Baldwin Dancy and covers a Waldorf understanding of child development from birth through three years. It originally appeared in Mothering,Spring 1987 and has been updated for this posting. It may be reprinted if full credit is given to the author and this web address is listed on the article.]

The imitative nature of the baby and young child is so obvious and so all-pervasive that we tend to be blind to it, unaware of its implications for parenting. Your child learns everything through imitation-walking, talking, toilet training, tying shoes, endless tasks. Imitation also manifests in expressions and gestures, as when we see and hear ourselves in our children’s play.

Rudolf Steiner, who founded Waldorf education, left a rich legacy for understanding the nature and development of the young child that can help parents nourish their whole child-body, mind, emotions, and spirit. It was through Steiner that I first became aware of learning through example and imitation, principles that I had observed in my own children without bringing them to consciousness.

Steiner states: “The little child, up to the age of seven, up to the change of teeth, is essentially imitative. He learns by doing what he sees being done around him. Fundamentally, all activities of the child’s early years are imitations.”1 How does this affect the young child–what does he or she imitate? Everything. Every action, every sight, sound, or other sense impression, every emotion from those around the child is taken in and absorbed right into the child’s inner being. Even when not obviously imitated or reproduced in the child’s actions, these impressions become indelibly etched in the child’s nervous system and can affect the development of the whole organism. Young children do not have the buffers and filters that adults have to block out impressions. Indeed, all that babies can do to stop the flow of impressions is go to sleep.

The awareness that the French obstetrician Fredrick Leboyer brought to our understanding of the newborn’s sensory experiences was explained by Steiner 50 years earlier. He said, “In the first part of life, before the change of teeth, the child is, so to say, altogether a sense organ. This we have to take very literally. What is the characteristic action of a sense organ? It is receptive to impressions from the environment. If something striking occurs near him-for example, a burst of anger-then the reflection thereof goes right through the child. It will affect even his blood circulation and digestive system. “2

A baby and young child will benefit from a calm and loving environment, especially one in which attention is placed on rhythm and repetition, and not on overwhelming the baby with sense impressions. Americans are enthusiastically taught to stimulate their babies for early development. This seems to grow out of a misinterpretation of studies which showed that babies in orphanages failed to thrive for lack of a primary caregiver and lack of stimulation. What is needed is the attention of loving parents who hold, cuddle, and are responsive to the child-not flash cards, activity boards, or plastic mobiles.

Babies need the loving attention of their parents and they need to be shielded from over-stimulation. While baby carriers increase contact between mother and baby, they also become a means of transporting babies to places where the quality of the sights and sounds are so invasive that the children would frequently be better off at home. I took my first child to a large discount department store when he was 10 days old, something I would not do again! Most parents are initially aware of the openness of the senses of the newborn, but they lose this awareness as the uniqueness of the birth slips into the “everydayness” of life.

Protecting the Senses
The senses of the newborn remain wide open long after birth. Because of this, some parents like to put colored silk over the baby’s basket to soften the light during the first few months. Similarly, parents can attend to the quality of the sounds their baby hears. No one is advocating tiptoeing around a baby; the baby needs to become accustomed to the sounds of your household. But it is worthwhile to ask about the quality of the sounds, “Are they connected to life?” Mechanical sounds from radio, television, tapes, or stereo not only have a different vibrational quality, but they also lack a living force behind them. Steiner explained how such mechanical sounds could have a detrimental effect on the developing discriminatory function of the hearing apparatus as well as on other organs. Taped lullabies and television programs, which take the place of singing to our babies or interacting with our children, also produce sound having a mechanical quality that is best avoided until after the age of seven.

In a similar way, images on television, movies, or computer screens are two-dimensional and composed of dots and emissions that can affect the developing organs and vitality of the child, regardless of the educational content of the programs. For this reason, and because television keeps young children passive and immobile when their nature is to be in movement, parents and teachers working out of the indications of Rudolf Steiner recommend that children under seven not watch television or play video games. It is helpful to realize that the effect of television on an older child is very different from its effect on a young child. The task of the first seven years, according to Steiner, is the determination of the health and vitality of the body’s organs, which is directly influenced by all that the child takes in. Anthroposophical medicine, which Steiner developed and which is well recognized in Europe, details the relationship between various illnesses in later life and the interaction of sensory impressions on the hereditary predisposition received from the parents.

With regard to the sense of touch, most parents realize the value of skin-to-skin contact with their newborn. And an increasing number of parents are using natural fibers, because they “breathe” and can help to prevent newborn rashes. Fibers from living sources such as wool, silk, and cotton have subtle qualities, which Steiner described as enhancing (rather than depleting) the body’s energy
–important considerations for children and adults of all ages. Hospitals have substantiated this by reporting that premature babies gain weight faster when placed on wool sheets.

Clothing also relates to the sense of warmth, which is especially important in the young child since it helps to determine how connected the consciousness of the child is with his or her body. Remember how sitting in an overheated room could put you to sleep, while a crisp autumn day could make you feel invigorated and ready for action? Young children need evenness of temperature, and slightly on the warm side because they are dreamier and not yet as fully “on the earth” as adults. They are usually unable to accurately report when they are cold because they do not yet have much awareness in their limbs. Keeping young children adequately clothed is an adult’s task, even if the children assure you that they are warm enough.

Many nurseries are now putting stockinette caps on babies to prevent heat loss. Actually, continuing to cover the head in the first year is valuable because it will protect the baby’s fontanels. These soft spots, with brain tissue just underneath the skin, can take up to a year and a half to close. A hat protects the central nervous system and the infant’s sensitive energy center in the top of the head (the crown chakra), which remains wide open until the fontanels close.

Keeping the head covered is also an important way of protecting the baby and young child from direct sunlight, which has an extremely powerful effect. This fact is well known in other countries, where often only North American visitors let their babies run around in just a diaper. Waldorf preschool teachers attest to the beneficial effect of hats, for they have found that when the children wear sun hats in May and June, they tend to be less wild and “out of themselves” when they come in from outside play.

Imitation and Discipline
A baby’s consciousness is dreamy and diffused, connected with the body but also surrounding it. Have you ever walked into a newborn’s room and wondered how such a small baby could somehow fill the entire room? Because of this quality of consciousness, it is impossible to spoil a baby; babies are not yet sufficiently aware of themselves as separate beings to be able to learn manipulative behavior. Rather, meeting a baby’s needs teaches him or her that the world is a trustworthy place.

Discipline in the early years can only be understood in terms of guidance. To discipline a young child is to provide an example of how things are done. If we remember that children learn by imitation, then we can correct them through our own example, and with positive statements rather than commands. For example, you might say, “We eat with a spoon” while you demonstrate this for the child, rather than saying “Stop eating with your fingers” or losing your temper.

Just as taking control of the body is a gradual process which proceeds from the head downward, so the awakening of consciousness of the “I” is also a gradual process. We could say that the child “grows down and wakes up.” A contraction of consciousness occurs from the diffused, undifferentiated consciousness of the baby to the more focused, concentrated, and self-centered awareness of the two year old. This first dawning of self-awareness during the third year is repeated again at ages 9 and 13 with even greater power.

The “Terrible Twos” seem more terrible because of our perception that the child begins to be “willful,” to misbehave “on purpose.” This is true in the sense that suddenly we are aware of a new “doer” being present, of someone who can consciously oppose our will with his or her own. But the young child still has no memory or moral sense of right and wrong (which, Steiner says, begins to develop at age five). Knowing about this inpouring of the child’s sense of self can help parents to stay calm and accept it as a necessary stage of development.

The most effective way to correct behavior in the young child is to provide an example in movement rather than to reason it out. In these times when many women are questioning patriarchy and authoritarianism, some mothers feel ambivalent about getting their child to obey and may engage in endless disputes as a result. You correct your child by virtue of the “natural authority” you have as his or her parent, teacher, and guide into the adult world that your child will one day join. Instinctively, the child accepts your authority along with your love and care. It is confusing to the child to be treated as your “equal” in this respect, and to be provided with countless reasons, threats, promises, or options. In fact, reasoning with your child is not very appropriate before the age of nine. Instead, out of your inner conviction that creating good habit patterns in early childhood is beneficial, you might say with absolute conviction, “We stay at the table until we’re finished,” as you remain seated while your child eats. Or, “It’s time to put the toys away,” while you hand your child a truck and put a horse away yourself. Children find it almost impossible to resist movement–imitation is part of their nature. However, if you start reasoning with your child to get him or her to do what you want, your child will imitate that and become a five year old who can talk you into doing things with great success.

Rhythm, example, and consistency go a long way toward preventing discipline problems. If naptime occurs every day at the same time, it becomes a part of life, not something that invites resistance. Or, if bedtime occurs every night with the same kind of ritual (pajamas, brushing teeth, lighting a candle, story, song, and prayers, for example), then going to bed will not raise questions or problems.

Avoiding problems and correcting your child without any sense that he or she should have “remembered to do it right” can help you to keep your perspective. Scolding or shouting is not effective; it simply forms part of the impression that the child takes so deeply into himself or herself. Remember, no one is perfect, and our own inner efforts and work on ourselves are the best things we can do for our young children. Striving to be models worthy of imitation (with renewed resolve rather than guilt) is the hardest and the most valuable work of parents, and it has the most benefit for our children. To help frazzled parents replenish their energy, Steiner suggests: sleep, meditation, and artistic activity.

Walking: The Task of the First Year
The earliest learning tasks of the child involve gaining control of the physical body–crawling, walking, talking, using the toilet. Children have a desire to be “big” and an innate capacity to walk upright and use language, but they first must encounter models to imitate in order for these skills to develop. For example, in rare cases where children have been raised by animals in the jungle, they never achieved an upright posture; similarly, children must be exposed to speech in order for language to develop.

The age at which a child walks, talks, or reaches other developmental milestones unfolds naturally, according to that child’s inner timetable. Comparisons with siblings or neighbors’ children will usually only create anxiety. Nature knows best what your child needs, and developmental stages should not be hurried or skipped. It is like fussing over a seed and digging it up to see if it is growing, when all it needs is sun, water, soil, and to be left undisturbed to grow naturally. Parents, having provided a healthy environment in which their child can grow, must then remain comfortable with the wide range of normal. (Be sure to seek answers to your questions, and either relax with reassurance or else enlist professional help in the rare cases where it is necessary.) The current “Superbaby Syndrome” can sometimes accelerate early achievement, but Steiner would say that it does so at the price of later physical health and well-being.

Gaining control of the body and learning to walk are the basic tasks of the first year. We can notice how control spreads from the head downward: starting first with the eyes, then the neck, then the trunk in learning to roll over, and finally the legs in learning to creep, crawl, and walk.

Developmental therapists now tell us that children who bypass the crawling stage often have coordination and learning disabilities in later life. Movement helps to stimulate and pattern the brain, and no phase should be skipped or hurried. For this reason, there is a twofold value to the baby in being horizontal until he or she can sit and stand independently. The first is that the time of crawling is not foreshortened, as it is with the use of baby walkers. The second is that the weight of the head and brain are not placed on the central nervous system before the baby can support them. Thus, baby walkers and other devices that set the child prematurely upright do the baby a disservice. Our plastic baby carriers also contain this design flaw, whereas in many other cultures where the young baby is carried in a sling or shawl, he or she remains horizontal much longer.

Baby gymnastics are fine for the adult companionship they provide for mothers, but they are not needed for a baby’s physical development. Children need to be allowed to unfold, with parents present to share in their unflagging attempts at mastery and their pride of accomplishment.

Talking: The Task of the Second Year
It is most common for walking to develop before talking, because speech sounds are related to body movements. For example, Steiner states that the forming of words has a certain parallel with the way in which the child can bend the fingers or keep them straight. Once a toddler is able to walk, speech usually develops rapidly.

In addition to being able to move, the child must also be exposed to speech in order for language to develop. Naturally, talking to your baby in clear, adult sentences provides a better model to imitate than does speaking in “baby talk.”

Speech is, at first, an expression of the child’s feelings, not thinking. First words express pure desire or wish. “Mama!” “Cookie!” or “Hurry!” convey whole sentences. The next phase involves naming things, which is a uniquely human act and shows the developing ability to form concepts about the world outside of oneself.

Thinking: The Task of the Third Year
Through imitation, simple speech and naming develop into full sentences and talking, so that the two year old usually has a fair command of language. Language provides the mold out of which thinking develops as the two year old becomes more aware of himself or herself as being separate from the world.

The young child is the center of his or her universe, unaware of distinctions between inner and outer, self and other. Before the third year, children usually refer to themselves by what they hear, such as “Mary do it” or “Joey’s car.” Their first spoken “I” corresponds to what popular psychology has called “The Terrible Twos.” This stage can better be understood (and weathered) as a time encompassing a first experience of self or individuality.

For thinking to unfold, the child must first have developed speech and also memory, which holds together sequences of experiences that the “I” gradually forms into concepts and ideas. By the age of three, the child has developed localized or “place memory,” and is starting to develop rhythmic or “time memory” and concept memory. But the child is still unable to form pictures or to call up memories at will without sensory reminders. This ability does not develop until about the age of six.

The Three Year Old
The development of thinking, memory, and the sense of self all involve separating oneself from the world. The next phase involves the three-year-old child’s reuniting with the world through creative play, as fantasy makes its first appearance. In play, we see the young child imitate all aspects of the surrounding world in an ever-changing way.
[To continue, see Rahima’s article on “Learning through Play.”

Notes
1 Elizabeth Grunelius, Early Childhood Education and the Waldorf School Plan (New York: Waldorf School Monographs, 1974), p. 41.
Ibid., p. 42.

Parenting the Nine Year Old

Recorder 2 Boys.jpgI wrote this article to describes the developmental changes of the nine-year-old child and how parents and Waldorf education meet this psychological stage. It first appeared in Motheringmagazine.
For further information we also offer a CD of a workshop by Daena Ross on “The Nine-Year Change: Leaving the Garden.” Click here to see more information.

Parenting the Nine Year Old
by Rahima Baldwin Dancy

Parents of nine year olds often wonder, “What is happening to my child?” Children at this age can become very critical and argumentative, or very moody and withdrawn. Nightmares, irrational fears, headaches and stomachaches often arise. Some children feel as if no one at school likes them, or others become suddenly self-conscious about being rich, poor, or otherwise “different.” Parents may be accused of being unfair or of not understanding, as the child rushes off and slams his or her door.

Searching for an explanation for the changes in behavior, parents sometimes blame a new teacher, a recent move, changes in the family such as separation or the birth of a sibling, or simply “growing pains”. An understanding of what is actually taking place can help us avoid needless worry and provide the support and guidance that children need during this time.

What is Happening?
The special needs of the nine year old are the result of an important change in consciousness that marks the end of early childhood and the transition to a new developmental phase. Rudolf Steiner, the founder of Waldorf education, states, “In the ninth year the child really experiences a complete transformation of its being, which indicates an important transformation of its soul-life and its bodily-physical experiences.”

Earlier, before the age of five or so, the child has a dreamlike state of consciousness in which the outer world and inner experience end to flow together. Outer events are not “observed,” but are deeply taken in through unconscious imitation. Whereas babies learn nearly everything through imitation, kindergarten-age children continue to imitate many aspects of their world, such as the movements of the teacher or parent.

While the power of imitation is so strong, the child feels united with the world and experiences no sense of aloneness. But with the loss of this power around the age of nine, the child feels separated from the world. Something that was hidden and slumbering begins to awaken. Nine year olds suddenly have a strong experience of themselves as separate beings, with a new feeling of distance from the world and other people. This sense of self, first experienced around age two-and-a-half, recurs now in a much deeper way, as the inner emotional life of the child begins to develop.

Although children react differently to leaving the sweet, dreamlike world of early childhood, one response is nearly universal: children become more conscious of their surroundings. You will probably find that what was once passed by unnoticed is suddenly focused on and questioned. This awakening to the world may be met with quiet astonishment or sharp criticism, depending on the child’s temperament.

A critical child may notice whether the statements people make are grounded in the real world or are a veneer. He or she may begin to question parents and teachers, wondering, “How do they know everything?” and, indeed, “Do they really know everything?” Something in the child is seeking reassurance that the authority of the adult will stand the test of quality, and that it carries an inner certainty.

In contrast, another child may become more withdrawn and start to look under the bed at night, or may have frequent stomachaches in response to this new sense of being alone. Parents whose children suddenly want to be alone often feel as if they are “losing” their children, as if the children no longer want to share their developing inner worlds. This is a time when intimations of mortality and death can enter a child’s consciousness. Religious questions and concerns about good and evil may also emerge with the child’s increased self-awareness and sense of choice and responsibility.

Usually, within six months after the ninth birthday (and sometimes earlier), the children are profoundly aware of this new sense of separateness between the self and the outer world. As the “I” penetrates into awareness, children begin to experience themselves as self-contained beings. The often feel as though they are in a threshold situation, poised, as it were, on the cusp of their own destiny. A 70-year-old woman wrote of this time in her life: “In this year I had a significant I-experience. I had just come from school in the city and had to change trams. In this moment of waiting, the complete certainty came to me that now all of life lay before me and that I was the one that must travel it.

Essentially, the nine year old is experiencing his or her own identity-to become a separate individuality, able to confront the outer world. Ideally, the child comes through this difficult time with a sense of connection with his or her higher self, a kind of “knowing” that will remain even after the heightened awareness is integrated.

My son spent many difficult months in the throes of “the nine-year change.” One night, as he popped out of bed for the third time, I had to muster great self-control to say, “What now?” “I’m glad I’m me!” he announced, radiating like the sun. He went on to explain, “It’s just like the song “The Age of Not Believing.” The words of the Disney song ran through my mind: “You must face the age of not believing, doubting everything you ever knew. Until at last you start believing, there’s something wonderful in you.” We all shared in his joy and thanked God that family life could once again return to normal.

Parenting Tips 
What can parents do to help their child through this important turning point at age nine?
– Understanding what is happening will help both your child and yourself as a parent. When both parents, or parents together with the teacher, consider a child and his real needs, it can help give the child balance. Be patient– this, too, shall pass. Ten is a wonderfully harmonious time between the crisis at age nine and adolescence, when the next intensifying of self-consciousness occurs.
– Be willing to let your child have her own inner emotional life. You can’t “fix it.” Honor her need for privacy or her sudden impatience with a younger sister. Be willing to let go and tolerate distance. Your relationship is changing and will improve again once alterations have been completed. Be nearby with understanding and reassurance that she is still loved.
– Share your thoughts with your child about things that go beyond the every-day affairs of life. But don’t limit your child by providing “answers” or definitions that can’t grow within the child when asked about things like God or death.
– Have faith in self-healing, in your child’s ability to come through this phase. Support individual artistic activity that attracts your child (writing poetry, keeping a diary, drawing or painting, music).
– Support your child’s interest in the world by providing opportunities to build things, visit a farm, plant a garden, do work in the real world. Encourage a connection with the plant and animal kingdoms and with simple human creative activities now before the child explores the world of technology, which is more appropriate for adolescence.
– Nourish your child with stories that illustrate the interconnectedness of life and the powers of fate and destiny. The story of Joseph and his coat of many colors has this element of the dream heralding his destiny and the patience he needed to see it manifest. In the curriculum of the Waldorf schools, the Old Testament stories are .told in third grade because they mirror 2- the inner state of the nine-year-old child. The creation story, for example, describes the child’s own experience of leaving the paradisiacal realm of early childhood, acquiring new self-awareness, and with it the added dimensions of choice and increasing responsibility for one’s actions. In fourth grade the heroic tales of the Norse myths represent the exploits of the new ego in larger- than-life fashion. The Waldorf curriculum also introduces the child to the world through projects in house-building, farming, and the study of the plant and animal kingdoms, not as abstract sciences, but in relation to the human being.
– Recognize that the child needs to establish a new respect for adult authority that goes beyond the blind acceptance of the younger child. Parents can encourage this by honoring a child’s new relationship with a teacher or other adults in his life. Steiner states, “What matters is that at this moment in life, the child can find someone–whether this be one person or possibly several persons is of less importance–whose picture it can carry through life.”(3) Parents can also help themselves be this kind of authority by presenting a united front to the child and by both sitting down with the child when questions of discipline arise (single parents may want to bring in a teacher or other adult during this time).

The magnitude of the changes that a child of this age is going through can be better understood if you contemplate the differences between the child of seven and the child of twelve. The seven year old is light-hearted and always in movement. The limbs are active for learning (through touching, doing, walking the times tables, and so forth). In contrast, the head is relatively large and still dreamy. The seven year old is just beginning to get adult teeth. His or her emotions are easily influenced by impressions from the world, with tears changing to smiles relatively easily.

The twelve year old, on the other hand, has a head that is very awake for thinking and longer limbs which seem heavy, tired, and often awkward to control. There is a rich and sometimes over-powering inner emotional life; the older child brings a great deal more to each experience. Physically, the sexual organs are beginning to mature as the child enters puberty.

The nine-year-old is in the middle between the world of early childhood and the world of adolescence. The physical and emotional changes which you may observe in your nine-year-old child are the outer manifestations of the tremendous change in consciousness which is going on within the child’s expanding inner world. By understanding the nature of these changes, we can better provide support in parenting the nine year old.

Awakening to the world and a new sense of self brings with it a new need: to understand the real world of everyday life, while at the same time long for intimations of something beyond ordinary life. As parents and teachers, our task is to become loving authorities for the growing child, sharing both a true picture of the world and a sense of our own inner striving.

Notes
1. Quoted in Hermann Koepke, Das neunte Lebensjahr (Dornach, Switzerland: Philosophisch-Anthroposophischer Verlag, 1983), p. 41.
2. Ibid., pp. 32-33.
3. Rudolf Steiner, Soul Economy and Waldorf Education (Spring Valley, NY: Anthroposophic Press, 1986), p. 167.

For More Information
Branston, Brian. Gods & Heroes from Viking Mythology. New York: Schocken,1982.
Colum, Padraic. The Children of Odin: The Book of Northern Myths. New York: Macmillan, 1984.
Crossley-Holland, Kevin. The Norse Myths. New York: Pantheon, 1981.
de Paola, Tomie. Parables of Jesus. New York: Holiday House, 1987.
Horn, Geoffrey, and Arthur Cavanaugh. Bible Stories for Children. New York: Macmillan, 1980.
Stoddard, Sandol. The Doubleday Illustrated Children’s Bible. New York: Doubleday & Company, 1983.
Wilkinson, Roy. Old Testament Stories and Commentary on the Old Testament Stories. Available from Rudolf Steiner College Bookstore.

[This article is copyright 2012 by Rahima Baldwin Dancy and may be reproduced in full as a handout if reference is given to www.waldorfinthehome.org]

http://www.informedfamilylife.org/category/online_store_your_growing_chil

ทำกระบวนการกับกลุ่มพ่อแม่ (โปรแกรม parenting ) ในโครงการทศวรรษแห่งการสร้างสมองเด็กเกาะยาว กองทุนส่งเสริมสุขภาพตำบล ปีที่ 3 ซึ่งก็ปรับกิจกรรมกันมาเรื่อยๆ

9.00- 10.00 เปิดพื้นที่เรียนรู้แบบมีส่วนร่วมกับกลุ่มพ่อแม่รุ่นที่ 2 หาโจทย์ที่ต้องแก้ ช่วยกันกำหนดทิศทางการสร้างความรู้ไปบน timeline ชีวิตครอบครัว เริ่มจากนมหยดแรก ฟันซี่แรก ของเล่นอันแรก ภาพวาดรูปแรก

(PBL ทำอย่างจะใช้กระบวนการพัฒนาEF แบบง่ายๆ practical ไปกับการเติบโตขึ้นของเด็กในแต่ละปีตามแนวทางมนุษยสนปรัชญา) โดยสร้างความรู้ร่วมกับพ่อแม่)

10.30-12.00 workshop ดูแลเด็กเล็กอย่างไร EF ดี ไม่ติดมือถือ (หัวข้อนี้ระดมคิดมาจากพ่อแม่)
โดยวิทยากรรับเชิญ คุณหมอ กิ๊ฟลัน ดอเลาะ จิตแพทย์จาก รพ.นราธิวาสราชนครินทร

U Theory กับการฟัง

ทฤษฎีตัวยู (Theory U) หรือการฟัง 4 ระดับ

  • ระดับแรก Downloading ฟังแบบดาวน์โหลด คือรู้แล้ว เอาความรู้ในอดีตเข้ามาอธิบาย อันนี้อาจจะฟังได้ตื้นที่สุด
  • ระดับที่สอง Factual ฟังมากขึ้นหน่อยแต่ก็ยังเช็คกับเหตุผลของตัวเองอยู่ ถูกหรือไม่ถูก ฟังเพื่อโต้แย้ง ฟังเพื่อตอบ ไม่ได้ฟังเพื่อเข้าใจ เป็นการ debate คือฟังมากขึ้นแต่เต็มไปด้วยเงื่อนไข ถ้าไม่ถูกก็จะโต้กลับและตั้งคำถาม
  • ระดับที่สาม Empathetic ฟังลึกลงไปหน่อยแต่จะไม่อยู่กับเหตุผลแล้ว แต่ฟังเพื่อหาความรู้สึก เพราะความรู้สึกสะท้อนสิ่งที่เค้าให้คุณค่า ทำไมเค้าพูดเรื่องนี้ อะไรมันมีคุณค่าสำหรับเค้า
  • ระดับที่สี่ Generative ระดับลึกที่สุด การเข้าไปเป็นส่วนหนึ่งของเรื่องราว เหมือนเป็นคนเดียวกัน เข้าไปนั่งอยู่ในใจ สัมผัสได้ เข้าใจถึงสิ่งที่เขาให้คุณค่า ได้รับผลจากการเข้าไปเป็นส่วนหนึ่ง เช่น รู้สึกสั่นสะเทือน พองโต ทราบซึ้ง ไม่ได้หมายความว่าเราจมอยู่กับอารมณ์ของใครอีกคน แต่ว่าเข้าใจมากกว่าแค่ความคิด เป็นการฟังเพื่อค้นหาตัวความเป็นไปได้ใหม่ๆ ตัวตนใหม่ๆ หรือภาพในอนาคตที่ต้องการให้ปรากฏhttps://thepotential.org/2018/06/15/theory-u/

 

ขอบคุณพี่ณัฐฬส

Introducing a Standardized Acupuncture Protocol for Peripheral Neuropathy: A Case Series

Dimitrova A. Introducing a Standardized Acupuncture Protocol for Peripheral Neuropathy: A Case Series. Med Acupunct. 2017;29(6):352-365.

Background: Peripheral neuropathy (PN) is defined as damage to the peripheral nervous system caused by a primary lesion or dysfunction. Multiple recent trials have suggested that acupuncture is beneficial for treating neuropathic pain. One challenge in acupuncture research is the lack of standardization of point selection, number of needles used, needle-retention time, needling depth, amount of needle manipulation, and use of moxibustion and electroacupuncture (EA).

Objectives: This article presents a standardized acupuncture protocol for the treatment of PN that incorporates structural acupuncture principles based on proximity to peripheral nerves and on traditional approaches to the treatment of neuropathic pain.

Materials and Methods: Ten consecutive patients diagnosed with large- or small-fiber neuropathy of various etiologies were treated with a standardized protocol, based on anatomical correlations of peripheral nerves and acupuncture points. Manual acupuncture was applied to left LR 4, LU 5; bilateral LI 11, KI 27, ST 36, GB 34, SP 6, SP 9, LI 4, TE 5, and BaFeng (except for the space between the first and second digits of the toes; LR 3 was used for that space). EA was applied to bilateral KI 3–1 and bilateral ST 41–LR 3. Patients underwent at least six acupuncture sessions, although the total number of sessions varied. Outcomes were measured using a visual analogue scale (VAS) and clinical signs and symptoms.

Results: All 10 patients indicated improvement on the VAS and in clinical presentation.

Conclusions: This standardized protocol appears to be effective for the treatment of neuropathy of various causes, including large- and small-fiber involvement. Further studies with larger sample sizes and randomized comparisons against sham acupuncture and other acupuncture regimens will be helpful to determine if this protocol could be established as a guideline for approaching peripheral neuropathy.

Keywords: : electroacupuncture, neurologic disorders, pain management, neuropathic pain, manual acupuncture
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733739/

Acupuncture Found Effective For Tinnitus

Researchers find acupuncture effective for the alleviation of tinnitus. This is significant given the intractability associated with this disorder. A research team in Sichuan, China, achieved significant positive patient outcomes by employing the use of electrical stimulation to acupuncture points. Compared with conventional manual acupuncture therapy, the addition of electroacupuncture to the treatment protocol increased clinical effectiveness for the treatment of tinnitus by 25.1%. Conventional manual acupuncture achieved a 64.5% total effective rate; however, electroacupuncture achieved an 89.6% total effective rate.

 

Ear Sanjiao on a Doll

 

The Sichuan research team cited prior research and Traditional Chinese Medicine (TCM) theory as the basis for the development of their electroacupuncture clinical protocol. Zhang et al. identified acupuncture point Tinggong (SI19) as an important area for the treatment of tinnitus in prior research. The Sichuan researchers included SI19 in the study because the work of Zhang et al. finds SI19 effective for benefitting the ears, reducing tinnitus, improving conduction in the auditory nerves, and because electroacupuncture creates rhythmic contractions of the muscles in the region of the ear to promote circulation and subsequent delivery of nutrients to the hearing system.

The Sichuan researchers outlined the acupuncture procedure that achieved the clinical successes. In addition, they reviewed TCM diagnostic considerations for patients with tinnitus. In general, tinnitus is categorized as either excess type or deficiency type. Excess type is often exacerbated by anger, anxiety, and panic. This type is often related to liver and gallbladder inflammation that is either internal organ (Zang Fu) or acupuncture channel (Jing Luo) related. This diagnosis is referred to as liver fire and gallbladder excess that disturbs the ears by blocking the qi in the shaoyang meridian, in part, with damp-heat stagnation. Deficiency related tinnitus is often due to kidney or liver deficiency preventing nourishment from benefitting the ears. Diagnostically, this may be deficiency affecting the shaoyin and jueyin acupuncture channels.

Two acupuncture treatment groups were compared in the clinical study. One group received electroacupuncture stimulation to the acupoints and the other groups received only manual acupuncture stimulation using reducing and reinforcing techniques. The primary acupoints used in the study were the following:

  • Tinggong (SI19)
  • Tinghui (GB2)
  • Yifeng (TB17)
  • Fengchi (GB20)

Secondary acupuncture points were added based on diagnostic considerations. For qi stagnation with blood stasis, Hegu (LI4) and Sanyinjiao (SP6) acupoints were added. For qi and blood deficiency, Qihai (CV6) and Zusanli (ST36) were added. For hyperactivity of liver and gallbladder fire, Taichong (LR3) and Qiuxu (GB40) were added. For kidney qi deficiency, Taixi (KD3) and Guanyuan (CV4) were added. For insufficient kidney qi and yang, Shenshu (BL23) and Mingmen (GV4) were added. For hyperactivity in the channels affecting the liver, Zhongzhu (TB3) and Waiguan (TB5) were added.

After acupoint site disinfection, filiform acupuncture needles were perpendicularly inserted. For excess syndrome, reducing (xie) techniques were applied. For deficiency syndrome, reinforcing (bu) techniques were applied. The deqi response was directed toward eliciting sensations towards the ears. Upon arrival of deqi, Tinghui (GB2) and Yifeng (TE17) were connected to a model G-6805 electroacupuncture device. A continuous wave was set to intensity levels at patient tolerance levels. This was achieved by starting at a very low intensity level of stimulation and slowly raising the amperage. The duration of electrical stimulation was 30 minutes.

Treatment was applied once per day for 15 days to complete one course of care. A total of 2 – 3 courses of care were applied. Using this protocol, manual acupuncture achieved a 64.5% total effective rate and electroacupuncture achieved an 89.6% total effective rate.

Researchers from the Central Hospital of Otolaryngology and Head and Neck Surgery in Chaoyang City achieved an 80% total effective rate using a different protocol. They used the following acupoints for the treatment of tinnitus:

  • Yiming (extra)
  • Tianyou (SJ16)
  • Fengchi (GB20)
  • Wangu (GB12)
  • Tinggong (SI19)
  • Shangyang (LI1)
  • Kunlun (BL60)
  • Juegu (GB39)
  • Ashi
  • Zhongzhu (KD15)

In a related study, Song et al. achieved significant clinical results for the treatment of tinnitus. Perhaps the most important aspect of the study by Song et al. is that the patient inclusion criteria sorted for intractable tinnitus. Only pernicious cases of tinnitus were admitted to the study.

Exclusion criteria sorted for cervical dysfunctions and ear deformities. Also excluded were patients with head injuries, anemia, diabetes, hypothyroidism, hypoglycemia, and autoimmune diseases. All patient admitted to the study had tinnitus for at least 4 months and up to 11 years. The total effective rate was 91% using the following set of acupoints:

  • TB17 (Yifeng)
  • GB2 (Tinghui)
  • SJ21 (Ermen)
  • SI19 (Tinggong)
  • SJ3 (Zhongzhu)
  • LR3 (Taichong)
  • GB40 (Qiuxu)
  • LU7 (Lieque)
  • GB43 (Xiaxi)

Acupuncture points TB17, GB2, and SJ21 were unilaterally applied to the affected side, where applicable. If the tinnitus was unilateral, the patient rested on their side during the treatment. For bilateral tinnitus, patients rested in a supine position. Manual acupuncture stimulation was applied to bring about the arrival of deqi. Similar to the earlier study mentioned in this article, electroacupuncture was applied to local ear acupoints using a continuous wave. Total needle retention time was 30 minutes. Acupuncture treatments were administered once per day for a total of ten days.

Ginger moxibustion was applied. Ginger was sliced into 1 cm thick cubes, each with a tiny needle punctured hole in the center. Moxa was placed on the ginger and ignited. The ginger was placed on the outer auricle region to warm the area.

The statistics demonstrate important patient outcomes: 64.17% of all patients fully recovered, 14.71% had significant improvements, 11.76% had slight improvements, 8.82% had no improvements. The total effective rate was 91.18%. The researchers concluded that manual acupuncture combined with electroacupuncture and ginger moxibustion is effective for the treatment of intractable tinnitus.
References:
Zhao Y & Xie XY. (2013). Treatment Efficiency Observation of Electro-acupuncture for 48 Cases of Nervous Tinnitus. Chinese Manipulation & Rehabilitation Medicine. 4(4).

Zhang XT, Yuan GL, Xu M, et al. (2002). The effects of acupuncture on inner Tinggong acupoint to brainstem evoked potentials on patients with sudden deafness. Journal of TCM. 43:68.

Montazem A. Secondary tinnitus as a symptom of instability of the upper cervical spine: operative management. Int Tinnitus J. 2000;6(2):130–133.

Shore S, Zhou J, Koehler S. Neural mechanisms underlying somatic tinnitus. Progress in brain research. 2007 Dec 31;166:107-548. University of Michigan, Ann Arbor, MI.

Xue H. (2015). Treatments of cervical tinnitus between neck acupoints acupuncture and traditional acupuncture. Jilin Journal of Traditional Chinese Medicine. 35(9).

Adams PF, Hendershot GE. (1999). Current estimates from the National Health Interview Survey, 1996. Vital Health Star10. 200: 81-103.

Zhu Y. (2005). Tinnitus epidemiological investigation in Northern Shaanxi. Journal of Disease Control. 12(6): 149-150.

Yingli Song, Li, Shilin, Yan Xiao, and Jiang Wu. “Efficacy Observation of Acupuncture Combined with Ginger Moxibustion to Treatment of 34 Cases of Intractable Tinnitus.” Zhongyi Zhongyao (Traditional Chinese Medicine and Herbs) Aug. 2013: 277-278.