Effectiveness of conventional language therapy in stroke patients

Effectiveness of conventional language therapy in stroke patients Stroke is a major non-communicable disease of increasing socio-economic importance in aging populations. According to the world health organization (WHO) Global Burden of Disease report, stroke was the second leading cause of mortality worldwide in 1990 the third leading cause of mortality in developed countries, (1), causing approximately 4.4 million deaths worldwide. (2), the most recent estimates showed that in 2002, the number of deaths due to stroke reached 5.51 million worldwide, with two-thirds of these deaths occurring in developing countries. Stroke also is a major cause of long-term disability, has an enormous emotional socioeconomic impact on patient, families health services. Speech language problems are common sequelae of stroke that significantly impact the daily lives of stroke survivors. Reduced speech language skills have negative ramifications on the individuals social, vocational recreational activities, often leading to social isolation, loneliness. Given the importance of communication to the stroke survivors quality of life, it is essential that rehabilitation professionals recognized address the speech language disorders associated with stroke. Normal speech language is extraordinarily complex. A number of steps are required, some accomplished sequentially some in parallel that incorporate the following: Conceptualization of an idea generation of a communicative goal. Formulation of a grammatically structural sequence of verbal symbols (words), each consisting of an interacting set of ordered sounds. Selection of a series of neural commands (or) sensorimotor programs that will activate co articulated times, durations, intensities Central peripheral nervous system innervations of muscles of respiration, phonation, resonance, articulation to produce the intended acoustic signal. Stroke can disrupt any of the stages of speech language, resulting in one (or) more of the disorder of aphasia. Disruption to the initial stage involving the structure rules of the linguistic message results in aphasia. Aphasia has been defined as a multimodality language disorder resulting from damage to brain areas that sub serves the formulation understanding of language its components (i.e., phonology, syntax, morphology semantics). Brocas aphasia: It is a motor aphasia (or) non-fluent aphasia. In this type of aphasia, speech output is highly reduced and is limited mainly to short utterances of less than 4 words. The vocabulary access is limited and the sound formation by the patients with Brocas aphasia is often laborious and clumsy. The patient may understand speech relatively well and also be able to read, but be limited in writing. Brocas aphasia is often named as a non fluent aphasia due to the halting of the speech. Fluency: Non-fluent Slow effortful output Short phrase length (less than 4 words) Disrupted prosody of speech. Oral Expression: Agrammatism: Uses primarily substantive content words (nouns, verbs) with few functional words (pronouns, prepositions, articles), most sentences are simplified. May have an associated apraxia of speech. Auditory Comprehension: Relatively good comprehension except for sentences that involve syntactic complexity. Repetition: Poor. Restoration of normal communicational activities of patient is the primary goal of rehabilitation. To reach the aim the physiotherapist can use conventional language therapy and constraint induced language therapy. Conventional language therapy includes Exercise, Naming, Repetition, sentence completion, following the instructions of therapist and Conversation. The conventional language therapy helps the patient to relearn the simple communicable activities. Constraint induced language therapy includes Word Games like (i) Material constraint (use of minimal pairs), (ii) Shaping rule constraints (form sentences), (iii) Reinforcement constraints. The constraint induced language therapy helps the patient to improve the communicable activities. The combination of conventional language therapy and constraint induced language therapy would bring about excellent improvements in communicational activities. The commonly used parameter to evaluate the outcome of treatment procedures are the western aphasia battery. The parameter selected for this study is the western aphasia battery. The pre post test values of western aphasia battery will be computed in numbers for comparison. Thus the study intended to compare the effect of conventional language therapy versus conventional language therapy and constraint induced language therapy in improving the communicational activities of stroke patient. This study facilitates to find out the most effective treatment to improve the communicational activities of stroke patients in society at the earliest. AIMS AND OBJECTIVES AIM OF THE STUDY To compare the effectiveness of conventional language therapy versus conventional language therapy with constraint induced language therapy in the management of post ischemic stroke Brocas aphasia. OBJECTIVES OF THE STUDY To determine the effectiveness of conventional language therapy in the management of post ischemic stroke Brocas aphasia. To determine the effectiveness of constraint induced language therapy in the management of post ischemic stroke Brocas aphasia. To determine the effectiveness of conventional language therapy versus conventional language therapy with constraint induced language therapy in the management of post ischemic stroke Brocas aphasia To find out the effective treatment regarding language functional status in post ischemic stroke Brocas aphsia. HYPOTHESIS NULL HYPOTHESIS The null hypothesis states that there was no any significant difference between conventional language therapy versus conventional language therapy with constraint induced language therapy in the management of post ischemic stroke Brocas aphasia. ALTERNATE HYPOTHESIS The alternate hypothesis states that there was significant difference between conventional language therapy versus conventional language therapy with constraint induced language therapy in the management of post ischemic stroke Brocas aphasia REVIEW OF LITERATURE 1. Pulvermuller F, et. al., (2001) Conducted a study on patients having chronic aphasia were assigned randomly to one group to receive either conventional language therapy or constraint induced language therapy. Patients in both groups received the same level of treatment (30 to 35 hours) as 10 days of massed practice language exercises for the CILT group ( 3 hours/day minimum; for 10 patients) or over a longer period of approximately 4 weeks for the conventional language therapy group ( 7 patients). CILT led to significant and pronounced improvements on approved clinical tests, on self-ratings, and on blinded observer readings of the patients communicative effectiveness in day to day life. Results suggest that the language skills of patients having chronic aphasia can be improved in a short course by the use of an appropriate massed practice method that focuses on the patients communicative needs. 2. Swearengin JA, et. al., (2006) Conducted a pilot study on a group of individuals with chronic aphasia. Here we compared treatment that required forced use of the language modality, CILT, to treatment allowing all modes of communication. Both treatments were administrated intensively, using the same therapeutic stimuli tasks. The results suggest that whereas both interventions yielded positive outcomes, but CILT group showed more consistent improvement on standard aphasia measures and clinician judgments of narrative discourse. Thus these results findings suggest that CILT intervention may be a viable approach to aphasia rehabilitation. 3. Jerzy P. Szaflarski et. al., Conducted a pilot study on three male patients with moderate to severe post-stroke aphasia. They received CILT 3-4 hours per day for 5 successive days. Pre and post testing included formal language evaluation, linguistic analysis of story retell and mini communication activity log. Results showed substantial improvements in comprehension and verbal skills. Thus the results indicate that the CILT is useful tool in language restoration in after stroke. 4. Meinzer M, et. al., (2005) Conducted a study on 27 patients with chronic aphasia received 30 hours of treatment over 10 days. 12 patients were trained with CILT program, for 15 patients the training included a module of written language and an additional training in everyday communication plus CILT. The outcome measures included standardized neurolinguistic testing. The results showed more pronounced and increased language function for patients of the group CILT plus. Thus this effective intervention can be successfully used in the rehabilitation of chronic aphasia patients. 5. Sanjit K. Bhogal BA et. al., Conducted a recent study on aphasic patients had determined that intense aphasia therapy (CILT)over a short period of time has greater impact on recovery than less intense therapy over a longer period of time. Thus this study examines other aspects of aphasia therapy that may be combined to facilitate recovery. Several areas of aphasia therapy have proven to be more effective than others. 6. Cynthia M. Shewan et. al., (2004) Conducted a study on aphasic patients who received one of three types of speech and language treatment was compared with that in aphasic patients who received no treatment. One hundred aphasic patients were followed from 2 to 4 weeks post on set for 1 year or until recovery, using a standardized test battery administered at systematic intervals. Both treatment methods were provided, while the method provided by trained nonprofessionals approached statistical significance. Small group size prevented resolution of the question of whether one type of treatment was superior to another. Thus the results show that language therapy improves the language status of aphasic patients. 7. Robert Teasell, MD et. al., Conducted a study on post stroke aphasic patients. The aim of the study is to evaluate the relationship between the intensity of aphasia therapy and aphasia recovery. Alterations in mean scores from all studies were recorded. Intensity of the therapy was recorded in means of length of therapy, hours of the therapy provided per week, and the total hours of therapy provided. Pearson correlation was used to check the relationship between changes in average scores of outcome measures and the intensity of therapy. Studies that explained a significant treatment effect gave 8.8 hours of therapy per week for 11.2 weeks versus the negative studies that only gave 2 hours per week for 22.9 weeks. On a mean, positive studies provided a total of 98.4 hours of the therapy, whereas the negative studies provided 43.6 hours of the therapy. Total length of therapy time was judged to be inversely correlated with hours of therapy provided per week (P=0.003) and total hours of therapy given (P=0.001). To tal length of therapy was inversely correlated with mean changes in Porch Index of Communicative Abilities (PICA) scores (P=0.0001). The number of hours of therapy given in a week was significantly related to greater improvement on the PICA (P=0.001) and the Token Test (P=0.027). Total number of hours of therapy was significantly correlated with higher improvement on the PICA (P References and further reading may be available for this article. To view references and further reading you must purchase this article. 8. Kelly H et. al., (2009) Conducted a study on person with aphasia. They identified 30 trials involving 1840 randomized participants that were suitable for inclusion in this review. Overall, the review shows evidence from randomized trials to suggest there may be a benefit from speech and language therapy. 9. Karyn pingel et. al., (2010) Conducted a study on 9 patients with chronic non fluent aphasia and the patients are selected by Nonrandomized control trial. One group is treated with constraint induced language therapy and next one is treated with conventional language therapy. Both groups received treatment 3h/d, 4d/wk for 2 consecutive weeks. The main outcome measure is Western aphasia battery, Boston Naming Test, Action Naming Test, and linguistic analyses. Although participants in both groups evinced positive outcomes post treatment, the results suggest that CILT subjects showed increased performance on more measures than the traditional subjects. 10. Lynn Maher et. al., (2008) Conducted a study on 48 patients with chronic aphasia. They are randomly assigned for this study. After the treatment session results suggest that individuals with chronic aphasia made substantial, measurable change on a language battery following intensive CILT in regarding with a standardized assessment tool. The main purpose of this study is to investigate the effects of intensive, constraint induced language therapy (CILT) for individuals with chronic aphasia compared with traditional aphasia therapy. 11.loading please wait Berthier ML, et. al., (2009) Conducted a randomized, double blind, placebo-controlled, parallel group study of both memantine and CILT on chronic post stroke aphasia. Patients were randomized into two groups for interventions after baseline evaluations. The main outcome measure is Western aphasia battery and communicative activity log. In accordance with Western aphasia battery and communicative activity log the best outcomes were achieved combining memantine with CILT subjects. 12.Anastasia Raymer et, al., (2009) Conducted a study on a small group of patients with aphasia to examine the effectiveness of constraint induced language therapy (CILT), in which they are received CILT. In contrast to other aphasia treatment approaches like conventional language therapy. In CILT improved verbal responses than conventional language therapy in accordance with a standardized measurement tool. It is indicated by increase in assessment score. The treatment is provided on an intensive schedule, up to three hours per day for five days per week. Thus the result was concluded that CILT was useful in rehabilitation of language function in aphasia. MATERIALS AND METHDOLOGY MATERIALS Couch. Chair. Pillow. Token. Picture cards. Western aphasia battery scoring sheet. METHODOLOGY Study Design Quasi Experimental Study Design. Study Setting The study was conducted at out patient department in J.K.K. Munirajah Medical Research Foundation College of Physiotherapy, Komarapalayam and District Head Quarters Hospital, Erode under the supervision of the concerned authorities Sampling Method Convenient sampling method. Sample Size Thirty patients with Ischemic Stroke Brocas aphasia, who comes under the inclusion criteria, were taken for the study. Study Duration The study was conducted for a course of 4 months (5 sittings per week). Inclusion Criteria Age group 40-60 years. Both sexes. Right-handed persons Primary Language is Tamil. Adequate hearing and vision to participate in language therapy Unilateral Left CVA involvement Moderate To moderately severe aphasia. Non-fluent aphasia Cognition > 11(MMSE). Exclusion Criteria Degenerative or Metabolic illness. Severe depression or psychiatric disorders. Brainstem stroke. Recurrent stroke History of other neurological impairment (e.g. dementia) Non-Tamil speaking Deaf and dumb Severe apraxia of speech. Parameters Western Aphasia Battery Token Test. Mini Mental State Examination Porch Index of Communicative Abilities (PICA). Technique: Conventional language therapy Exercises Naming Repetition Sentence completion Following instructions Conversations on patients interest topics Constraint induced language therapy Constraint means: Avoiding the use of compensatory strategies such as gesturing, drawing, writing etc. Forced use : Means communicating by talking, and Massed practice : Means 2 to 4 hrs of speech therapy a day. Word Games Material constraints Shaping and rule constraints Reinforcement contingencies Procedure A total number of 30 patients having Ischemic Stroke Brocas aphasia who met the inclusion criteria were recruited by convenient sampling method. After the informed consent obtained, they were partitioned into two groups as Group A and Group B, with 15 patients in each. Hence prior to the onset of treatment, pre-tests were conducted using Western Aphasia Battery and results were recorded for both groups. After a clarifying demonstration about Conventional language therapy, Group A subjects were subjected to Conventional language therapy with supervised for a period of 4 months. After a clarifying demonstration about Conventional Language Therapy with Constrained induced language therapy, Group B subjects were subjected to Conventional Language Therapy with Constrained induced language therapy for a period of 4 months. In the last session, a post test was conducted using Western Aphasia Battery and the results were recorded. In fine, the analysis of the recorded results was carried out for the purposes of comparing the pre-test Vs post-test results, in turn the treatment techniques. Statistical Tool The statistical tools used in the study were pairedt test and unpairedt test. Pairedt test: The pairedt test was used to find out the statistical significance between pre and post test of patients treated with Conventional Language Therapy and Constrained induced language therapy in Ischemic Stroke Brocas Aphasia separately. Formula: Pairedt test: s = t = d = difference between pre test Vs post test values = mean difference n = total number of subjects s = standard deviation. Unpaired t test: The unpaired t test was used to compare the statistically significant difference between Group A and Group B. Formula: Unpaired t test: s = t = n1 = total number of subjects in group A n2 = total number of subjects in group B = difference between pre test Vs post test of group A = mean difference between pre test Vs post test of group A = difference between pretest Vs post test of group B = mean difference between pre test Vs post test of group B s = standard deviation. DATA PRESENTATION TABLE -I S.No GROUP- A Conventional Language Therapy GROUP- B Conventional Language Therapy with Constraint Induced Language Therapy Pre-Test Post-Test Pre-Test Post-Test 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 44 46 42 43 45 44 43 44 49 50 43 44 42 45 45 63 61 69 61 65 65 60 66 70 73 67 66 62 68 69 45 45 42 44 43 50 49 44 43 43 45 43 42 46 44 75 73 75 80 81 80 73 75 75 80 72 80 75 81 82 DATA ANALYSIS AND INTERPRETATION This portion deals with the analysis and interpretation of the data collected from group A and Group B who underwent Conventional Language Therapy And Constraint induced Language therapy TABLE II Group A Table II represents the mean values, mean difference, standard deviation, and paired t value between pre test Vs post test values of Patient Rated Brocas Aphasia Evaluation for group A who have been subjected to Conventional Language Therapy. Western Aphasia Battery Mean Mean difference Standard deviation Paired t value Pre test 44.6 21.07 3 26.31 Post test 65.67 It shows the analysis of Brocas Aphasia Evaluation; the paired t value of pre Vs post sessions of group A was 26.31 at 0.05 level of significance, which was greater than the tabulated value of 2.15. This showed that there was a statistical significant difference in between pre Vs post test results. The pre test mean was 44.6, the post test mean was 65.67 and mean difference was 21.07, which showed that there was a decrease in Brocas Aphasia Evaluation in post test indicating the recovery of selected samples in response to intervention. Graph I -Western Aphasia Battery Evaluation of Group A Pre Post test values TABLE III Group B Table III represents the mean values, mean difference, standard deviation, and pairedt value of Brocas Aphasia Evaluation for group B, who have been subjected to Conventional Language Therapy And Constraint induced Language therapy Western Aphasia Battery Mean Mean difference Standard deviation Paired t value Pre test 44.53 32.6 4.29 29.41 Post test 77.3 Table III shows the analysis of Brocas Aphasia Evaluation; the pairedt value of pre Vs post sessions of group B was 29.41 at 0.05 level of significance, which was greater than the tabulated value of 2.15. This showed that there was a statistical significant difference in between pre Vs post test results. The pre test mean was 44.53, the post test mean was 77.13 and mean difference was 32.6, which showed that there was a decrease in Brocas Aphasia Evaluation in post test indicating the recovery of selected samples in response to intervention. Graph II Western Aphasia Battery Evaluation of Group B Pre Post test values TABLE IV Table IV represents the comparative mean values, mean difference, standard deviation, and unpairedt value between group A and group B on Brocas Aphasia Evaluation. Western Aphasia Battery Mean Mean difference Standard deviation Unpaired t value Group A 21.07 11.53 3.7 8.54 Group B 32.6 Table IV shows the analysis of group A and group B with Brocas Aphasia Evaluation. The unpairedt value of 8.54 was greater than the tabulated unpaired t value of 2.05 at 0.05 level of significance which showed that there was statistically significant difference between group A and group B. The mean value of group A was 21.07 and the mean value of group B was 32.6, and the mean difference was 11.53 which showed that there was a greater improvement in group B when compared to group A. Therefore, the study is rejecting the null hypothesis and accepting the alternate hypothesis. Graph III Mean difference of Group A and Group B Western Aphasia Battery DISCUSSION The aim of the study was to compare the effectiveness of Conventional language therapy versus Conventional language therapy with Constraint induced language therapy in improving language function in ischemic stroke Brocas aphasia. Based on Berthier ML. et.al., (2009) Karyn pingel et.al., (2010) Studies Western Aphasia Battery was selected as parameter in present study. In the analysis and interpretation of Language function in group A: The paired t value of 26.31 was greater than the tabulated paired t value of 2.15, which showed that there was statistically significant difference at 0.05 level of significance and 14 degrees of freedom between pre and post results. The pre test mean was 44.6, post test mean was 65.67 and mean difference was 21.07, which showed improvements regarding language functional status in response to Conventional language therapy after 4 months. In the analysis and interpretation of Language function in group B: The paired t value of 29.41 was greater than the tabulated paired t value of 2.15, which showed that there was statistically significant difference at 0.05 level of significance and 14 degrees of freedom between pre and post results. The pre test mean was 44.53, post test mean was 77.13 and mean difference was 32.6, which showed improvements regarding language functional status in response to Conventional language therapy with constraint induced language therapy after 4 months. The results of studies conducted by Jerzy P. Szarflarski.et.al., Meinzer M et.al., Anastasia Raymer, supported the present study in which Conventional language therapy with constraint induced language therapy was given. IN THE COMPARISON OF GROUP A AND GROUP B: In the analysis and interpretation of Language Function between group A and group B: In the analysis and interpretation of Language function, the unpairedt value of 8.54 which is greater than the tabulated t value of 2.05, at 0.05 level of significance and 28 degrees of freedom, which showed that there was statistically significant difference between the pre test Vs post test results of group A and group B. The mean value of group A was 21.07, mean value of group B was 32.6 and mean difference was 11.53 which showed that there was significant improvements regarding language functional status in group B compared to group A in response to treatment. Based on the statistical analysis and interpretation of the results, the present study showed that there was significant improvement regarding language functional status based on (increase) in Western Aphasia Battery in patients with Ischemic Stroke Brocas Aphasia treated with Conventional language therapy with onstraint induced language therapy. Therefore, the present study is accepting alternate hypothesis and rejecting null hypothesis. Reason for Improvements in Conventional Language Therapy It increases the efficiency and strength of language skills. In conventional language therapy regular exercise and practices are used. It helps to strengthen the weak muscles and to prevent it from further degeneration. Reactivation of the cortex was due to increased responsiveness of weak inputs from neighboring areas. It takes over of existing descending pathways from premotor and supplementary motor cortex which is involved in language control. It used to help a survivor of an aphasic regain his ability to talk, recognize voice patterns and regain the ability to relate words to images. It helps to regaining control over the voice cords is an important part of therapy. Reason for improvements in constraint induced language therapy Constraint induced language therapy is very intensive treatment with sessions lasting for up to 6 hours over the course of 10 days so it gives repeated stimulus to brain. Constraint induced language therapy principles are motivated by neuroscience insights about learning at the level of nerve cells (synaptic plasticity). So it helps to regain language skills. Constraint induced language therapy contrasts sharply with traditional therapy by the strong belief that mechanisms to compensate for lost language function should not be used unless absolutely necessary, even in everyday life. It make coupling between cortical systems for language and action in the human brain and it reverses the elements of learned disuse. It produces some reorganizational changes during language practice. Reason for improvements in conventional language therapy with constraint induced language therapy It enhances both parallel and hierarchical processing with in central nervous system which induced stored areas of the brain and it result in enhancing effective recovery. It consists of various throat and neck exercises, such as Cognitive Linguistic Therapy. Cognitive Linguistic Therapy concentrates on the patients emotions, coaching them on how to respond to tones of voice or words describing emotions, such as happy. It encourages the patients (constrained) to use their remaining verbal abilities to succeed in the communication game. Here the interaction is guided by communicative need in a language game context, picture cards, and the barriers making it impossible to see other players cards, and other materials, so that it induces active participation of patient. It is believed that CILT works by the mechanism of increased neuroplasticity. By constraining an individual to use only speech, it is believed that their brain can reestablish old neural pathways and recruit new neural pathways to compensate for lost function SUMMARY AND CONCLUSION SUMMARY The aim of the study was to compare the effectiveness of Conventional language therapy alone with combined effect of Conventional language therapy and constraint induced language therapy on language function in Ischemic stroke Brocas aphasia. A total number of 30 subjects with Ischemic stroke Brocas aphasia were selected by convenient sampling method after considering the inclusion and exclusion criteria. Then informed consents were obtained from subjects individually. Western Aphasia Battery was taken as the parameter. Pre test data were collected for group A and group B patients and computed. Group A patients were subjected to Conventional language therapy and Group B patients were subjected to Conventional language therapy and constraint induced language therapy for a period of 4 Months. The results of the same parameter were recorded for comparison after four months of treatment. The paired t test was used to compare the pre versus post test results of Group A and Group B separately. The unpaired t test was used to compare the mean difference of

John Steinbeck †“Of Mice and Men” Coursework Essay

‘Of Mice and Men’ written by John Steinbeck set in California near Soledad in the 1930’s on two men called George and Lennie who travel together from ranch to ranch trying to make their life like the † American Dream† what Lennie shares with George. During this time there was a depression in America, which meant unemployment and Racism was high so men had to go to different ranches. Racism and bad employment at this time in the United States was called â€Å"The Great Depression.† After The Great Depression, World War 2 had started and John Steinbeck decided to write the book â€Å"Of Mice and Men† what was influenced also by a poet called Robert Burns who was Scottish and also had released a book in the past. Later â€Å"Of Mice And Men† was published in 1937. The American Dream in the U.S.A is thought to be for any American to go through hard work and courage to achieve the goal of their life leading them to success. Lennie and Georges Dream was to own a farm house with lots of chickens and rabbits. â€Å"The American Depression† what had been the harshest depression ever what was from 1929 leading to 1939. This Depression started in North America what went on to Europe and other areas of the world. Although it was started in the united states because of the fast economic growth, it lead the whole world to a disaster. This was originally started because of over production in agriculture what lead to rising debt with farmers. The ranch where Lennie and George end up working for was near Soledad, which is south east of Salinas, Weed was nearby. Soledad what meant lonely was an ideal setting to the story for people who could translate Soledad into English. All of the ranchers with them are lonely with no family and never have anything to look forward to just their daily routines and also just thinking of â€Å"The American Dream†. After the ranchers do their routines the only kind of entertainment what they do is play cards. The ranchers belong to no – one what everyone knows â€Å"Guys like us, that work on ranches are the loneliest guys in the world . . . They got no family†. This also adds to the fact that the ranchers are missing out from a lot in their life’s as they have no family or friends to share their fun with and they have no life only sadness. Ranchers don’t seem happy as they never have any fun entertaining things to look forward to like normal people so they just carry on with their lives in loneliness and misery. George Milton who is a small and intelligent man with sharp feutures. He is Lennies carer as he always has to take care of him and be beside him through everything as he is, his only friend. After George’s aunty died he had to look after Lennie as he was the only one he could talk to, but got fed up as Lennie talked like a child. Even though George leads Lennie out of problems what he gets him self into accidentally he loves him a lot but doesn’t like to show it. Lennie Small is large and has a shapeless face. He drags his feet when he walks, and lets his arms hang. He has a child’s brain as he doesn’t really remember anything and looks up to Lennie as he leads him in the right way and always helps him in bad situations. Lennie in the story gets compared to an animal more than a human as he is a really big man who is mentally retarded â€Å"Dragging his feet a little, the way a bear drags his paws†. George and Lennie relation differs from the other ranchers as they travel together where ever they go and are not lonely as the other ranchers as they have got each other. Crooks is an old black man, he is called this because he has a crooked back he is the stable worker, with a personality just like Candy’s. Crooks doesn’t like company like candy and also wants to live for George and Lennies dream. He has a small place where he lives by himself because of his color as he can not stay in the bunk-house. Lennie gets along with crooks more than anyone else as their resemblances are the same. Crooks is one individual who spends most of his time reading and is a fairly clever person, he lives in a small space, with no one with him. He is segregated because of his color. â€Å"Crooks said, long as you won’t get out and leave me alone.† He is not allowed in the bunk-house to play cards as the other ranchers say he stinks, but he tells Lennie â€Å"You all stink to me† Candy is an old man with one arm who works as a swamper. Candy had an old dog but agreed to kill it as the entire ranch workers were complaining that it smelt â€Å"we can’t sleep with him stinkin around in here†. Candy is very attached to his dog which he had since it was a pup, and was the only thing he could really talk to. When he hears about George and Lennie’s dream of getting their own place, he asks them to take him with them and offers them his savings to help. He offers his money to them as he doesn’t have any other family to share his savings with. Candy becomes very happy, as he thinks he will not be lonely again, but these dreams are broken in the end. Curley the bosses’ son who was a welt weight boxer. He is short and wanted to prove that he wasn’t a laboring man. He acts as he is superior to anyone else in the ranch. He goes around like he is the boss but no one dares to go up to him as he is a strong boxer. Curley is quite a violent man and in the story he ends up getting in to a fight because he thought that Lennie was laughing at him â€Å"No big son-of-a-bitch is gonna laugh at me†. Curleys wife who is always left lonely and no-one respects her, Curley never pays attention to her She is forced to flirt with other ranchers to get attention however, she does not get it as everyone knows Curley will be furious if he finds out and any one who will try it with Curleys wife will get into very big trouble with the boss. She is one of the loneliest people in the story as everyone neglects her and never pays attention to her so she is forgotten out from everyone else. Even though she dresses up like a tart she doesn’t achieve anything wit the other ranchers. Even when she tells Curley â€Å"I never get to talk to nobody, I get awful lonely† she still gets neglected. The people who are most lonely in the story are Candy, Crook and Curley’s wife. Candy is lonely because, he has no family or friends. His only friend was his dog who he could talk to. â€Å"I’ve had his since he was a pup.† This shows that the main people who are lonely are really different from normal people as they never have anything to look out for. George and Lennie’s relation is very strong unique friendship as none of the other ranchers travel with anyone else or share experiences traveling together or either copeing with life together. They are good friends because they share the same dream of owning a farm. George wanted to be his own boss. Lennie wanted, to pet animals all day long and they both believed that it will come true and even when George has doubts he encourages Lennie. They both know how important they are to each other and Lennie likes it when George tells him that â€Å"I got you and you got me†. They both look out for each other as they depend on one and other, they haven’t got no one else like friend or family † Ranchers are loneliest guys in the world they got no family†. In the end George has to kill Lennie to save him from being killed by the other ranchers what would have been twice as bad seeing a close friend die. â€Å"The American Dream† was something what George and Lennie truly believed in. Without the dream no – one would have nothing to look forward to but George and Lennie were well in way of thinking about their future. This was their main objective through out the story of owning a big farm together even crooks and candy got involved in with the dream John Steinbeck wanted each characters individual self to have some thing to look forward to in their up and coming life. To the end of the story Lennie goes to the place where George told him to go if he got into any trouble near by the river. Then Lennie began to think and imagined a rabbit who told him that George would get rid of him because, he is sick of him. And when George comes to the place where he had told Lennie to wait Lennie asks that if he would leave him and George replies back no. Then Lennie decides to leave but George says no and reminds him of the Dream they had planned of them two owning a farm with Furry rabbits and lots of land. But then George tells Lennie to look across the river and Shoots him with the gun to the back of his head. Slim guesses what had happened and reassures George that it had to be done in the end for the best. This was very important for George to do as he can live a life where he doesn’t have to look out for some-one else rather than him self. But also George will become really lonely without Lennie besides him and also their Dream of being together in a big farm had been destroyed. But now George can settle down and think about how he is going to go on with the rest of his life and what job to do without him keeping to move. The thing that has died with Lennie is everything that George and Lennie had. George had done everything for Lennie and could take no more. He had protected him so much an always encouraged him to the max. George killed Lennie as a good friend to save him from harsh misery. The theme of loneliness in this book is important If the characters in the book weren’t lonely then they wouldn’t have done the things that they did and so there wouldn’t have been the same. Curley’s wife and Lennie die because of loneliness which causes George to be even more lonely. If Curley’s wife hadn’t been lonely she wouldn’t have started the conversation with Lennie which caused her death.

Race And Discrimination Between Men And Women Essay

The article that has been chosen regards to race and discrimination between men or women throughout their lifetime. In this article, it states statistics data of woman children suffering because of the women’s race. Like if they are a specific race; they are more likely to be in a difficult situation which may or may not include their child’s life. Being a Hispanic young woman, it is really interesting to learn about the percentage number of experiencing something in the near future that may affect me negatively or positively than other women of another race. Also, in this article; it states how if a certain race woman partnered up with a man of another race; then, there is a high possibility of the man experiencing discrimination from the woman’s family. The reason for the discrimination is the family doesn’t want the women to marry or partner up with anybody outside their race or culture. They would rather have her marry someone within their race. That author also states that the scientists have conducted an experiment where they see the statistics of babies’ low birth weight, size for gestational age, preterm birth, and infant mortality. Women from all races should read this article because if they are planning to start a family in the near future, they should know the statistics of their life and child’s life due to their race and background. The issue of this article is based on the couple’s race/ethnicity; this may cause stress to the mother during pregnancy becauseShow MoreRelatedDiscrimination In The Kite Runner1698 Words   |  7 PagesFor centuries, society has been plagued with the sickness that is discrimination. People have taken it upon themselves to have the right to discriminate against others, basing their prejudice on parts of others that they themselves cannot control such as age, race or gender. From past to present, many have faced segregation and the damaging ripple effect it has on their lives. 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The Short Game Story in Sportswriting

There are lots of different kinds of stories you can write on the sports beat, but probably the most basic is the short game story. A short game story, usually 500 words or less, follows a straightforward format that can be applied to any game you cover. The Lede The lede of your story should include the final score and some details about what made the game interesting. Generally, this means focusing on the efforts of an individual player. Let’s say a team’s star athlete is injured and a previously unheralded player comes into the game as a substitute. Not much is expected of this rookie but he defies expectations and plays a great game, leading the team to victory. Example 1: Second-string quarterback Jay Lindman, who had never played a down for Jefferson High School, came off the bench after star QB Fred Torville was injured Friday night and threw three touchdown passes to lead the Gladiators to a 21-14 victory over the McKinley High School Centurions. Or maybe the game is a close, seesaw battle between two evenly matched opponents, and is won in the final seconds by an especially dramatic play. Example 2: Second-string quarterback Jay Lindman threw the game-winning touchdown with just 12 seconds left to lead the Jefferson High School Gladiators to a 21-14 victory over the McKinley High School Centurions Friday night. Notice that in both examples we focus on the efforts of an individual athlete. Sports is all about the human drama of competition, and focusing on a single person gives the game story a human interest angle that readers will enjoy. The Body of the Story The body of your story should basically elaborate on the lede. If your lede was about the benchwarmer becoming the game’s star, then the body of the story should go into more detail about that. Often a simple chronological account works best. Example: Torville’s ankle was sprained when he was sacked in the first quarter. Lindman came into the game with low expectations but threw his first touchdown pass in the second quarter with a high, floating ball that receiver Mike Ganson snagged in the end zone. In the third quarter, Lindman was forced to scramble out of the pocket to avoid the rush but managed to fire a bullet to receiver Desean Washington, who made a diving catch at the goal line. The Wrap Up The wrap-up, or ending, of your story usually centers on quotes from the coach and players gleaned from post-game interviews or press conferences. Getting great quotes for sports stories can sometimes be tough—coaches and athletes often speak in clichà ©s—but a snappy quote can really be the icing on the cake of your game story. Example: â€Å"I knew Lindman could play but I didn’t know he could play like that,† said Gladiators coach Jeff Michaelson. â€Å"That was one heck of a game by a young guy who showed a lot of heart.† Washington said Lindman exuded confidence even in the huddle before his very first snap. â€Å"He just said, ‘Let’s do this to win,’† Washington said. â€Å"And he went out there and did it. That boy can throw the ball.†