The lower extremity is affected infrequently in adult-onset primary dystonia in contrast to childhood-onset dystonia, which typically begins in the foot. When dystonia affects the foot in an adult, it is usually on a secondary basis. We present findings on 17 patients (11 women, 6 men; average age of onset 48.4 years; average time to diagnosis 2.7 years) with adult-onset primary foot dystonia. Prior to diagnosis, most patients underwent extensive testing and treatment, including unnecessary surgeries. Only the left lower extremity was involved in 8 patients, only the right in 7, and both in 2. The most common patterns were plantar flexion of all toes and inversion of the foot, typically activated with standing or walking. Only 2 patients had dystonia elsewhere. There was a family history of possible dystonia in 2 patients. One of five tested for DYT1 was positive, in the absence of a family history. One of eight patients treated with levodopa experienced mild improvement. Six of eight treated with botulinum toxin improved. No patient has been observed to have a secondary cause of dystonia. The prognosis, with regard to progression or spread to other body parts, has been favorable. Although uncommon, foot dystonia on a primary basis, not due to DYT1, can begin in adulthood. In this series of patients, the diagnosis was often not recognized, leading to extensive and unnecessary testing and treatment and emphasizing the need for wider recognition.
This article reports findings from a case study designed to explore, compare, and describe a selected group of Asian American students' entry perspectives, expectations, and preservice socialization experiences in teacher education, medical, and law schools in a large state university. The study shows that all Asian American students chose to enter the human service professions primarily for humanistic and altruistic reasons and that they were sensitive to diversity issues. However, they were not sufficiently self-conscious of their own obligations to serve as role models for minority children and youth, and nothing in their formal or informal socialization experiences deliberately cultivated such awareness. In addition, many of them felt alienated from the mainstream faculty and field advisers. Findings from this study have strong implications for improving the recruitment and preparation of minority students in professional schools.
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