Speech-language therapist services for people with Parkinson's disease in the UK are restricted on most dimensions. Management practices often do not match guideline suggestions. Consideration needs to be given to the training for, content of and delivery of speech-language therapy services for people with Parkinson's disease.

Hippotherapy (Greek hippos = horse) is a specialised physiotherapy treatment that makes use of the horses' unique three-dimensional movement impulses at a walk to facilitate movement responses in patients sitting on the horse's back (Strauss, 2000). Despite a substantial body of anecdotal and clinical evidence for its benefits, research evidence for hippotherapy is sparse. This questionnaire survey was the first study in a series of investigations exploring the views of physiotherapists and people with cerebral palsy who use hippotherapy. These investigations, in turn, form the basis from which the authors will recommend outcome measures for individuals with cerebral palsy in a hippotherapy environment. This study aimed to: (a) establish the pattern of hippotherapy practice in Germany and the U.K.; (b) examine the perceived main effects of hippotherapy on people with cerebral palsy in Germany and the U.K.; and (c) investigate how these effects are being measured in both countries. The results highlighted considerable differences in how hippotherapy is practised in the U.K. compared with in Germany. In spite of this, the study revealed agreement among respondents on the overall perceived effects of hippotherapy on individuals with cerebral palsy, namely, the regulation of muscle tone, improvement of postural control and psychological benefits. The results also indicate scant use of outcome measures to evaluate these effects. The impact of these findings is discussed in the light of published research, and suggestions for further research are made.

( 2 0 1 0 ) Journal of Nursing and Healthcare of Chronic Illness 2, 102-112 Dementia and risk: contested territories of everyday life Aims. The project aimed to understand the construction of risk in dementia care from the perspective of the person with dementia, family carers and practitioners with the intention of developing negotiated partnerships in risk management. Background. This paper addresses a gap in the literature by embedding constructions of risk within everyday events and social contexts, and communicates such constructions through the voices of people with dementia, carers and practitioners. Method. This symbolic interactionalist study involved data collection by interview with 55 people with dementia (sometimes twice), and their nominated carer and practitioner. The sample was drawn from three regions of the United Kingdom. Data were collected during 2004. Conclusions. Five 'contested territories' of everyday living with dementia are outlined in this paper: friendships, smoking, going out, domestic arrangements, and occupation and activity. These contested territories are purposeful and allow for 102Ó 2010 Blackwell Publishing Ltd sense making, maintenance of self, claiming and relinquishing decision making, and creating purpose(lessness) in people's lives. Relevance to clinical practice. Assessing and managing risk in a way that respects the dynamics and purposes of contested territories will support care that is person centred, and moreover respectful of the relationships that contribute to maintaining the individual's sense of self and purpose.Key words: carer, contested territories, dementia, everyday life, risk, symbolic interactionism IntroductionThe paper addresses the complex area of risk management in dementia care. It described a qualitative study in which 55 people with dementia were interviewed, together with their nominated family member and carer. The findings demonstrate the everyday ways in which people with dementia experience risk and its impact on their sense-making, and their identity, purpose and control over their lives. As such, the paper contributes to a growing awareness of the critical importance of the ways in which the micro-dynamics of people's lives are affected by others and it offers a way of intervening to support the identity of the person with dementia.

Although there is now some evidence for specific effects of hippotherapy on people with cerebral palsy, these studies fail to provide a comprehensive picture of the effects of hippotherapy. This was the first qualitative study to explore the hippotherapy experience of people with cerebral palsy from a user perspective. The effects of hippotherapy and their context were of particular interest. Seventeen users aged from 4 to 63, with or without their parents, participated in focus groups or individual interviews in six centres in Britain and in Germany. The main effects of hippotherapy, as identified by users and parents, are normalisation of muscle tone, improved trunk control, improved walking ability, carryover effects of hippotherapy to activities of daily living, and increased self-efficacy, confidence, and self-esteem. This study provided unique and new insights into the context in which hippotherapy happens, as well as its effects on impairment, activity, participation, and quality of life in people with cerebral palsy. The study's findings are integrated with the existing literature on motor learning and pedagogy to try to explain the complex effects of hippotherapy as reported by users and parents. A conceptual framework that illustrates these effects and their interactions is introduced.

Contemporary nurse education places a high value on learning in the clinical environment. Combined with increasing numbers of students there are unprecedented demands on clinical areas and staff. One response to this problem has been the development of the practice placement facilitator (PPF) role. This study aimed to evaluate, over 12 months, the impact of the PPF role on the provision of practice placements, student support during placement and professional development needs of staff as clinical supervisors/assessors. The evaluation focused on three areas: capacity to accommodate students; quality of placements in relation to the role of the PPF; and the evolution of the role of the PPF. Data‐collection methods included interviews, focus groups, questionnaires and secondary data analysis. The findings of the study demonstrated that: many different groups of learners are present in clinical environments; students need to have continuity of support; clinical staff derive benefits from an enhanced understanding of the needs of learners through the work of the PPF; and that if the role and function of the PPF post is unclear and/or poorly maintained there will be detrimental effects.

Despite the need for services which are culturally appropriate there is a dearth of robust research on the impact of ethnic background on dementia and caregiving. A literature search has revealed a relative lack of published research from the UK, with more US studies available. This paper provides a review of the literature on these topics and includes a critique of ethnicity categorisation and commonly held assumptions. It explores the complexities of the concept of ethnicity and examines its significance in relation to understandings of health and illness in general, and dementia in particular. Ethnic background appears to account for differences in experiences of dementia and caregiving, but other compounding variables, including socio-economic factors and education, also need to be taken into account when considering the experiences of specific ethnic communities. The paper concludes that ethnicity is significant in regard to how people experience dementia and caregiving, but also highlights a continuing need for research which explores the impact of ethnic background in a sensitive and sophisticated manner.

Increased understanding of how dementia is experienced by partners of people from specific ethnic groups with dementia can equip nurses to give culturally appropriate advice and support. The study findings suggest that ethnicity alone cannot account for individual responses to dementia in a partner, and therefore awareness of cultural factors needs to be balanced with sensitivity to the unique life experience and relationships of the individuals.

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