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For example, individuals diagnosed with Angelman syndrome are ``characterized by severe developmental delays or mental retardation, severe speech impairment or absence of speech, gait ataxia or tremulousness of the limbs, mild cortical atrophy or dysmyelination. Patterns of participation in recreational and leisure activities among children with complex physical disabilities. Providing neuropsychological services to learners with low-incidence disabilities. Sex by age by physical disability for the civilian noninstitutionalized population 5 years and over. The tasks provide an assessment of five domains: upper and lower body strength, upper body flexibility, balance and coordination, and endurance. Samples of the tasks include carrying a pan of water for 1 m, making a double bed with a fitted sheet, comforter and pillows, and getting into and out of a bathtub. Zero is assigned to individuals unable or unwilling to perform a task; one for performance in the bottom 10% of performance, and 12 for the top 10% of performance. The norms were established in 78 individuals living in the community who were, on average 72 years of age. Domain scores are obtained by summing the scaled scores of each item within the domain; a total score is obtained by averaging the five domain scores. Continuous-Scale Physical Functional Performance in healthy older adults: A validation study. Continuous-Scale Physical Functional Performance Test: Validity, reliability and sensitivity of data for the short version. Use of the Continuous Scale Physical Functional Performance Test in stroke survivors. Within these frameworks, the primary focus is on the impact of impairment and various risk factors on functional outcomes. The ultimate goal is adaptive functioning, empowerment, and quality of life for the disabled individual. Regarding interventions in particular, the current emphasis is on evidence-based practice. Synonyms Movement science; Physiotherapy Cross References Compensatory Strategies Disability Functional Compensation Definition the treatment of individuals with various forms of physical and neurologic dysfunction from disease or injury by promoting restoration of function. A postgraduate degree is required for all state licenses, and most entrylevel physical therapy positions in the United States now require a doctorate (D. Common treatment approaches for these problems include manual strengthening exercises, stretching, joint manipulation, gait training, and muscle reeducation via biofeedback. Other ``therapeutic modalities' include hot packs and ultrasound for muscle tension and spasms, cold packs for inflammation and swelling, transcutaneous electrical nerve stimulation for pain reduction, and electrical stimulation for muscle strengthening and healing. It is rarely visible to the eye and may be heightened by strong emotion, physical exhaustion, hypoglycemia, hyperthyroidism, heavy metal poisoning, stimulants, alcohol withdrawal, or fever. Current Knowledge Examples of substances may include dirt, paint chips, clay, leaves, pebbles, etc. Pica is considered a disorder when the behavior is not developmentally appropriate. The etiology of pica has not empirically been determined, but hypotheses include nutritional deficiencies, cultural factors (ingestion of starch, soil, or clay is regarded as acceptable by various groups), low socioeconomic status, learned behavior (especially in children with developmental disabilities), or underlying biochemical disorder. Pica is a potentially serious disorder depending on the toxicity of the substance being ingested (such as the ingestion of lead from paint chips). Behavioral interventions to reduce the pica of persons with developmental disabilities. Pathologists use this term on the basis of the histologic criteria of argyrophilic inclusions (Pick bodies) and ballooned neurons (Pick cells). However, because not all patients with these clinical presentations have Pick bodies at autopsy, and not all patients with pathological Pick bodies have one of these clinical presentations, there remains an absence of consensus about the proper use of this term in the literature (Kertesz, Munoz, & Hillis, 2003). Boeve (Boeve, 2007) provides an excellent review of the complex clinicopathological relationships in these forms of dementia.

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Examination reveals a resting tremor of the right upper extremity, accompanied by mild rigidity and slowness of rapid alternating movements. Which of the following medications is the best choice to treat the symptoms of this disease The pathophysiology of Parkinson disease is thought to involve dysfunction of the substantia nigra, including loss of neurons. Postmortem study of the substantia nigra of a patient with Parkinson disease is likely to exhibit which of the following A 48-year-old female psychiatric patient has parkinsonism secondary to long-term neuroleptic use. A 70-year-old woman has 1 year of worsening gait, right-hand tremor, and rigidity. If her disease progresses, the decrement in speech that would be expected would result in which of the following Even though the physiologic deficiency in Parkinson disease is of dopamine, L-dopa rather than dopamine is given to patients for which of the following reasons Dopamine is readily metabolized in the gastrointestinal tract to ineffective compounds. They seem to be getting worse, and now he also has involuntary obscene vocalizations. He may have largely normal behavior while being treated with which of the following A 72-year-old man presented 2 years ago with asymmetric rigidity, bradykinesia, and tremor. After several years of successful antiparkinsonian treatment, a patient abruptly develops acute episodes of profound bradykinesia and rigidity. Drug toxicity Questions 261 to 264 For each clinical scenario, select the most likely condition. A 53-year-old woman is unable to stop blinking forcefully and has frequent grimacing movements of the face. A 42-year-old woman has a long history of twisting movements of her head to the left. These are painful and have resulted over the years in muscular hypertrophy affecting the sternocleidomastoid and trapezius muscles. This has been present for 2 years, but has increasingly impaired her work ability because she is frequently required to take her clients to lunch, and she is embarrassed by her inability to eat and drink normally. A 64-year-old man has noticed dragging of the right leg and tremor and stiffness of the right hand. On examination, he has a tremor of the right hand, which disappears when he reaches to grab a pen. Questions 265 to 269 For each clinical scenario, select the most likely diagnosis. A 34-year-old man develops progressive depression and memory impairment over the course of 6 months. His initial neurological evaluation reveals a metabolic acidosis associated with his dementia. He has tremor and rigidity in his arms and walks with relatively little swing in his arms. A 19-year-old woman develops auditory hallucinations and persecutory delusions over the course of 3 days. Her medication is changed to a very low dose of thioridazine, and trihexyphenidyl is added. Over the next 2 weeks, she became much more animated and reports no recurrence of her hallucinations. A 65-year-old man develops slurred speech, difficulty swallowing, and labored breathing over the course of 30 minutes. His arms and legs are flaccid, and he exhibits no voluntary movements in any of his limbs.

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Upward deflections correspond to rightward, upward, or clockwise eye rotations, with respect to the patient. They may have vertical or torsional components and, occasionally, the former may be quite prominent clinically (359). Macrosaccadic oscillations are occasionally encountered in patients with myasthenia gravis after administration of edrophonium (360). Consequently, for a short period, saccadic gain is too high and the eyes oscillate either side of a visual target. The eye movement thus consists of a saccade away from the fixation position, with a rapid drift back. There is a continuum between saccadic pulses and saccadic oscillations without an intersaccadic interval (363, 364). The latter may occur in one direction, usually the horizontal plane, in which case they are called ocular flutter. Ocular flutter may be intermittent and mainly associated with voluntary saccades (flutter dysmetria) or convergence movements (365). Occasionally, the amplitude of the oscillations is very small (``microflutter') (366). In such cases, the movements may be detected only with a slit lamp or an ophthalmoscope or by using eye movement recordings, even though they are producing oscillopsia or other visual symptoms. Sustained opsoclonus is a striking finding, in which multidirectional conjugate saccades, usually of large amplitude, interfere with steady fixation, smooth pursuit, or convergence. Opsoclonus is often accompanied by myoclonus-brief jerky involuntary limb movements-hence the term ``opsoclonusmyoclonus. In children, about half the cases of opsoclonus are associated with tumors of neural crest origin, such as neuroblastoma. In adults, opsoclonus occurs most often in association with small-cell lung, breast, and other cancers (368). Anti-Ri is reported in association with cancer of the breast or pelvic organs and, less commonly, in patients with small-cell lung or bladder cancer. A second antibody, anti-Hu, has been reported with opsoclonus in two children with neuroblastoma and in an adult with small-cell lung cancer (372,378). A third type of antibody, directed against neurofilaments, was found in a child with paraneoplastic opsoclonus (379). Recent studies have emphasized the diversity of immunity to neuronal autoantigens (374), with only a minority of patients showing immunoreactivity to specific antineuronal antibodies (368). The prognosis of idiopathic opsoclonus (including patients with manifestations of brainstem encephalitis) is generally good (368). Some patients with paraneoplastic opsoclonus myoclonus show spontaneous remissions, irrespective of the underlying tumor (372). Patients whose tumor can be identified and treated may recover neurologically; those who are not treated have a more severe course (368). The oscillations are conjugate, with frequency and amplitude similar to those encountered in ocular flutter and opsoclonus. Although usually confined to the horizontal plane, voluntary nystagmus can occasionally be vertical or torsional (383), and may be accompanied by a head tremor (384). Voluntary nystagmus can be produced in the light or dark and with the eyes open or closed. It causes oscillopsia and reduced visual acuity and is often accompanied by eyelid flutter, a strained facial expression, and convergence.

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The other nonpharmacological therapies discussed in the review (homeopathy, vitamin E, magnetic devices and acupuncture) showed no significant benefit. Importantly, the safety of phytoestrogens in women with a history of estrogen-dependent cancer is unknown (Dennehy, 2006). A recent review on treatment of vasomotor symptoms recommended gabapentin, venlafaxine and fluoxetine for relieving vasomotor symptoms in breast cancer survivors, consistent with the Cochrane review (Murthy and Chamberlain, 2012). Risk-reducing salpingo-oophorectomy in young women can result in severe hot flushes, vaginal dryness, sexual dysfunction, sleep disturbances, cognitive changes and an increased risk of cardiovascular disease (Finch, et al. Induction of medical or surgical castration in women with endometriosis is effective in improving pain symptoms. Hysterectomy with bilateral salpingo-oophorectomy is not a preferred option for relieving pain symptoms in women with endometriosis and should be considered only in women who have completed their family and failed to respond to more conservative treatments (Good practice point) (Dunselman, et al. Recommendation For women with endometriosis who required oophorectomy, combined estrogen/progestogen therapy can be effective for the treatment of vasomotor symptoms and may reduce the risk of disease reactivation. Although not well studied, some recommendations can be derived from the literature. The evidence on which to base recommendations for these women is, however, sparse. Migraine with aura is a risk factor for ischaemic stroke, which may be greatest in younger women (under 50 years old) (Kurth, et al. A later systematic review from 2007 did not identify any evidence to change this view (MacGregor, 2007). Surgical menopause may be associated with an increased risk of stroke, which appears to be reduced by estrogen replacement (Parker, et al. These studies did not specifically consider any potential confounding effect of migraine. Surgical menopause appears to be associated with the highest prevalence of migraine when compared to natural menopause, presumably because of a sudden reduction of estrogen (see (Nappi, et al. Data for normal postmenopausal women with migraine is also minimal and conflicting. Transdermal estrogen may have the advantage of providing a constant level of estrogen and may be associated with a lower risk of thrombosis. A small, randomised trial of oral versus transdermal estrogen in postmenopausal women showed no increase in the frequency of migraine in the transdermal group but a significant increase in the oral group (Nappi, et al. Continuous combined regimens have the similar theoretical advantage of providing constant hormone levels. However, a large case control study of postmenopausal women over 45 years did not show any difference in migraine prevalence in women taking estrogen alone or estrogen with progestin (Misakian, et al. Although none of the women were clinically hypertensive, physiological therapy was associated with a lower blood pressure (P<0. In hypertensive postmenopausal women, most studies showed a decrease in systolic and diastolic blood pressure after estrogen therapy, although an increase was found in some studies. The effect of different progestins on blood pressure in hypertensive postmenopausal women is not well studied, but in general progestins do not seem to hamper the effect of estrogen on blood pressure. Recent studies have shown promising results for drospirenone, a novel progestin with aldosterone receptor antagonism, and therefore antihypertensive effects. Hormone therapy combining 17-estradiol with drospirenone has been shown to have a blood pressure-lowering effect in postmenopausal women with elevated blood pressure, in addition to effectively relieving symptoms of the menopause (White, 2007). Tibolone is widely used for vasomotor symptoms and it was found to be effective in relieving these symptoms (Formoso, et al. However, data on the long-term safety of tibolone are scarce but raise suspicion of increased risks for breast cancer and stroke (Formoso, et al. The study of Canonico and colleagues showed no significant association of micronized progesterone or pregnane derivatives. In addition, obesity is a risk factor for hypertension and coronary artery disease (see chapter 8), and premature death (see chapter 5). C Fibroids Uterine fibroids (myomas or leiomyomas) are benign tumours arising from individual smooth muscle cells of the uterus.

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Thus, the primary somatosensory and motor cortices for the right side of the body lie on either side of the central sulcus in the left hemisphere. The cortical areas for the face, mouth, and lips are located in the ventral portions of the gyri, near the lateral sulcus. The areas representing the arms and the hands are found more dorsally, followed by the trunk and the legs, with the upper part of the legs lying close to the longitudinal fissure that separates the two cerebral hemispheres, and the lower leg and foot being found on the medial surface of the hemispheres. In the case of the somatosensory system, because the lips, the tongue, and the hands are capable of finer tactile discriminations as a result of more dense populations of receptors at the periphery, there is greater relative amount of somatosensory cortex devoted to the processing of these inputs, especially compared to the truncal areas that are relatively less sensitive. Although when thinking about somatotopic organization, there is a tendency to consider only the cortex, similar patterns of organization can be found in other regions of the central nervous, including the distribution of fibers in the spinal cord, brainstem pathways, thalamus, and thalamocortical radiations. Definition Somesthesia is the perception of bodily sensations that include the skin, muscles, joints, and tendons. Such sensations would encompass the perception of pain, temperature, light touch, deep touch, vibration, proprioception (recognition of the relative position of a body part), and kinesthesia (awareness of movement of a limb or joint). While the visceral organs can also respond to certain types of stimuli, such as pains associated with the gut, these are not typically included in this definition. Cross References Kinesthesia Pain Perception Proprioception Somatosensory System Stereognosis References and Readings Haines, D. Source memory refers 2326 S Span of Apprehension to recalling the source of learned information, such as knowledge of when or where something was learned. Source memory failure may be associated with old age, stress, distractibility, or intoxication and is a phenomenon in which a person retrieves fragments of a memory without remembering how or when the fragment was acquired. Source memory impairments have been shown to be disproportionately impaired in patients with frontal lobe lesions. For instance, when asked to learn two separate lists of items, frontal lobe patients are impaired at determining if a word was on the first or second list. In contrast, medial temporal amnesics are impaired in recall of the actual items but not its source. The term span of apprehension is sometimes used interchangeably with attention span, though technically span of apprehension refers to a more basic processing capacity that influences attention span. Historical Background the construct of span of apprehension arose out of efforts in the field of cognitive psychology to demonstrate the processes by which information is transferred from sensory storage to short-term memory, and the constraints on this transfer. This span represents a disparity between what is perceived Cross References Incidental Memory Memory Memory Impairment References and Readings Baldo, J. Figure 1 An example of the type of visual presentation used in studying span of apprehension. An arrow points to the row of letters that the subject will attempt to recall following presentation of the stimuli. Task demands can be modified by varying the duration between stimulus presentation and recall, the number of stimuli in the array and the way cueing to location is performed Definition the maximum number of stimuli or units of information that can be processed at one time after brief presentation. Span of Apprehension S 2327 at a more basic sensory level, and what is available for retrieval. This disparity has direct relevance to distinctions between serial and parallel processing, with the times limits imposed by the decay process providing a capacity limitation on serial processing. Accordingly, it can be distinguished from attention span, which varies as a function of momentary changes in arousal, motivation, other attentional influences, such as interference. This maxima is strongly influenced by intrinsic neurobiological constraints, most notably the information processing speed capacity for particular individuals. This was demonstrated in dichotic listening experiments, in which information presented to one ear that was attended was more easily recognized and recalled, whereas stimuli going to the unattended channel was not. Performance on dichotic listening paradigms was constrained however by the span of apprehension. However, alterations in span of apprehension among schizophrenics occur as a function of length of asynchrony in stimulus onset and also masking. While relatively few systemic neuropsychological studies of span of apprehension exist, some research has demonstrated reduced span in patients with brain disorders. Some generalizations can be made based on what is known about the determinants of this span, and also limited clinical evidence to date. Neurological conditions that reduce the overall processing speed for information transmission and transfer across functional brain systems are likely to reduce this span.

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While Volkmann was interested in studying human vision from a physiological perspective, Cattell was interested in exploiting vision in experiments designed to gain insight into mental processes such as reaction time. A variety of other tachistoscopes were developed with a variety of names such as falltachistoscope and pendulumtachistoscope. The tachistoscope has been used to test the limits of human visual perception such as determining the minimum exposure time needed for visual apprehension of various stimuli including shapes, colors, letters, words, and numbers. It has been used in conjunction with degraded stimuli to assess the relationship between exposure time and amount of visual information needed to form an identifiable percept. In an early example of experimentation by Gestalt psychologists, Max Wertheimer used the device to study apparent movement by determining how rapidly a set of two visual stimuli can alternate before they perceptually fuse into a single steady state percept. The training involved rapid presentation of silhouettes of aircraft and pilots had to identify them as being friend or foe. The images were initially large and gradually were reduced in size while the exposure durations were also gradually reduced. Renshaw reportedly convinced Navy personnel of the value of his technique when he demonstrated that a group of students who had undergone training achieved 95% accuracy in plane identification with exposures of 100 ms, whereas a naval officer had 0% accuracy. Renshaw and others hypothesized that tachistoscopic training might result in a general improvement in form perception and that this, in turn, might result in increased speed of reading words and digit strings. This initial work using the tachistoscope to improve reading speed was done with U. With training, readers were able to fully recognize four words simultaneously flashed on the screen at a rate of 1/500th second (2 ms). Further research demonstrated that readers could increase their reading speed from 200 to 400 words per min. However, subsequent research generally demonstrated that gains in reading speed achieved with the tachistoscope did not generally persist without the machine. Today a number of commercial products are available that are aimed at improving reading speed and comprehension using tachistoscopic. These methods aim to widen eye sweep and scanning to help the reader take into as much information as possible in one visual sweep across the text. The tachistoscope came into prominence again in the 1960s, when Roger Sperry, Michael Gazzaniga, and Joseph Bogen pioneered the use of the lateralized tachistoscope to isolate presentation of visual stimuli to separate visual hemifields so that visual information could be presented separately to the right or left cerebral hemisphere. Sperry used the device to study hemispheric specialization in patients who had under commissurotomy for treatment of intractable seizures. In 1981, Sperry was awarded a Nobel Prize in Physiology or Medicine for this pioneering work. The general approach of presenting visual information to one hemisphere or the other has been used in patients with agenesis of the corpus callosum and in individuals who have sustained unilateral vascular or other lesions. Lateralized presentation of stimuli has also been used to study hemispheric dominance for certain stimuli or processes as well as hemispheric transfer of information in individuals with intact corpus callosum. The tachistoscope has been used widely in research on attention including stimulus detection and priming paradigms to explore hemispheric attentional bias for visual stimuli that differ along various dimensions such Tacrine T 2463 as modality. Definition Tachyphylaxis is the continued or repeated exposure to a drug that may lead to a weakened pharmacological response. This presumed to be a consequence of diminished receptor sensitivity in response to consistent stimulation by a drug agonist, which produces a diminished pharmacological response in consequence. This desensitization process can be a consequence of a decrease in the number of receptors or an attenuation of the response because the drug has promoted neurotransmitter release in excess of presynaptic production. For example, repeated administration of tyramine, which is a protein precursor to norepinephrine, tends to produce tachyphylaxis. Repeated administration of norepinephrine does not, and reverses tachyphylaxis to tyramine for reasons unknown. Psychometric Data Given that this is a device and not a test per se, norms do not apply. Norms for fourth and fifth graders for identifying 5-digit strings presented by tachistoscopic with exposure duration of 100 ms were developed in the 1980s. Clinical Uses the tachistoscope has been traditionally used in research on visual perception and attention in healthy and clinical populations. Improvements in reading rate and comprehension of subjects training with the tachistoscope. Cross References Agonist Norepinephrine Receptor Spectrum References and Readings Brunton, L.

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This occurs because the structures in question are at the same time piezoelectric (the ability of certain materials to generate an electric charge in response to applied mechanical stress48) and pyroelectric (the ability of certain materials to generate an electrical potential in response to applied thermal stress), which means they possess the capacity for thermal and mechanical polarization. Piezoelectrics convert mechanical energy into electric energy, while pyroelectrics convert thermal energy into electric energy [84]. Acoustic effects may take place not only in piezoelectrics, but also in semiconductors. In such cases, non-radiative recombination transmits the energy to the molecular It is worth noting that macromolecules spend almost their entire lives in states of mechanical stress. Due to the presence of bound ions and electrically charged parts of protein molecules (negatively charged carbonyls and positively charged amino acids), any mechanical shift is accompanied by changes of electrical field, which contribute to maintaining mechanical stresses within macromolecules. Therefore, an essentially mechanical behavior characterized by the presence of long-living stressed conformations play a crucial role in regulating morphogenesis, and can be distinctly traced already on the level of single macromolecules [81]. The transition from the induced state to the basic state has got thus two possibilities: the generation of photon or the generation of phonon. At micro- and mesoscopic level life is a result of all the chemical, electrical, magnetic, optical and acoustic events occurring in the living organism, in the system of organic-like semiconductors, piezo- and pyroelectrics. Therefor life takes place not in a chemical or electronic system, but to some extent among these two processes, where photon exchange plays a central role. Life processes and light are inseparable and internally connected due to their electromagnetic nature. Light plays a significant energetic and regulatory role in living organisms and in the entire ecosystem, for instance in photosynthesis, in the process of seeing, in biological rhythms, etc. The establishment and maintenance of biological structures is based on the process of photosynthesis49 [85] [86], thanks to which the surplus of energy supplied by the photon to the electron in the electronic excitation is converted into binding energy. In this case there is a transfer of energy from a bond to an excited electron, with the consequent emission of a photon. The electromagnetic interface and photon exchange are at the basis of all biological processes and it is thanks to it that a biological system, from the less to the most complex, interacts/interfere with each other and with the environment. Prokaryotic cells (unicellular autotrophic anaerobic photo, magneto and chemo-synthetic micro-organisms began to form ca. Messori themselves, that are poisoned by the gaseous oxygen, and dramatic effects on the whole environmental (geochemical evidence of a new world-order for the carbon cycle), climatological (ice ages began) and geological conditions (most of the minerals found on Earth will be since formed as hydrated and oxidized forms due to dynamic and crust processes). Some of the prokaryotes and most of the primitive eukaryotes who escaped extinction underwent a ca. Until the Cambrian Period, biological dynamics revolved around the development of biochemical and biophysical strategies, aimed at fulfilling energy requirements. From the Cambrian onwards a new solution amongst energy requirements started to sketch a second way for the development of life on Planet Earth: adaptation by diversification of behavioural strategies. Diversification of behavioral strategies require cell differentiation, the process by which cells specialize, acquiring or enhancing their ability to perform a specific function50. With cell differentiation the whole clusters of unicellular orgaAll cells have the fundamental properties of living protoplasm, i. When a cell specializes it loses none of these fundamental properties related to biological life, but it differs because it potentiates one of these properties. Generally speaking, when a cell specializes in a particular function, it also modifies its morphology. Messori nismsthat have colonized the planet until then, distributed over one or more areas and linked by a common adaptive and bio-energetic gain, found the way to come together, a process of in-formation governed by the self-organization of specific associative patterns induced, in the short and long range, by resonance phenomena (via Phase Conjugate Dynamics; Spin Coniugate Dynamics; Tension Coniugate Dynamics), involving various kind of cellular and molecular species, to become localized cells colonies, specialized and joined by a common structural and functional link, defined and identified in the construction of different tissues, organs and systems of organs, that operate coherently and in synchrony for the survival and unity of the multicellular system. From being a composed, integrated system delimiting (membrane) a multitude of sub-cellular structures and molecular units, more and more unicellular organisms stopped "dancing alone" to become one with an integrated specialized cellular ecosystem (multi-cellular organism), consisting of differentiated cells, specialized according to the role and function they must play to be part of a choral unit51. Messori the biological scenario in a multitude of animal organisms, guided by the genetic stabilization of specific sensory maps (bearers of a specific ability to generate interference) and specific neuronal maps (bearers of specific anatomical and functional correlations), which assigns to species their own capacities, possibilities and tendencies, variously bound to stereotypy or open to overcome it. The Mind-Brain-Body Hard Problem: Mind As individuals we experience ourselves as biologically discrete, as contained within our skins. Thus, we experience ourselves as embodied and largely define ourselves and our boundaries by our bodied experience. But also importantly, despite the ecological reality of our inextricable embeddedness, we are boudaried, defined, and located by others-and, so, we are also embodied by others. Vivien Hardham [99] What is here proposed to define the position of mind in Nature, is a relation- ship-based alternative. Physically, the mind phenomenon 1) rest on the neuro-electrochemical activity, that transmutes the environmental physic variations, filtered and made available by the six sensory organs, into a non-linear neuro-compatible stream of energy and tension gradients, 2) is drawn by the tuning (via correlative dynamics) of the ongoing non-locally distribution ofmonopolar tension gradients (a relationship process linked to the dynamics of the species-specific neurological basin of attraction acting at the edge of chaos on tension level), with the ongoing non-locally distribution ofe- nergy gradients (a relationship process linked to the dynamics of the same species-specific neurological basin of attraction acting at the edge of chaos on wave-particle level).

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Stuttering is ``disfluent' speech and is often characterized by the production of repetitions or prolongation of a sound or syllable. This disorder can also involve ``blocks' as when speech is halted and the individual struggles to produce a word or sound. He or she may rearrange the sentence or use unusual synonyms, or may decline to participate in a conversation. More severe stuttering may include secondary characteristics, such as tics or unusual behaviors that ``start' his or her speech. If the disorder is untreated, secondary characteristics can develop into a behavioral chain that is very distracting to the speaker and listener. It is defined as rapid and disorganized speech combined Cross References Apraxia Articulation Disorder Dysarthria Phonological Disorder Phonology References and Readings American Speech-Language-Hearing Association. Incidence and prevalence of communication disorders and hearing loss in children (2008 ed. Children may experience language delay if they fail to acquire language skills in a prescribed time frame. A language based learning disorder may develop in children with early language difficulties. This is characterized by difficulty in learning to read, write, and spell but may manifest in younger children as listening or speaking difficulties. Acquired language disorders can be classified as forms of aphasia and may result from insult to the part of the brain that is responsible for language. Aphasia can involve disruption of speaking, listening, reading, or writing skills. Pragmatic language is social language, such as greetings, maintaining eye contact with a listener, taking turns in a conversation, etc. A disorder with pragmatics is often diagnosed when the speaker lacks these interpersonal communication skills and lacks awareness of the skills. Categorization the American Speech Language Hearing Association groups communication disorders into disorders of children and adult onset disorders. There can be overlap, as when a childhood disorder continues to afflict the individual as they get older. Disorders of children include articulation, speech apraxia, phonological processing disorders, voice, fluency, and language disorders. Adult speech and language disorders include apraxia, dysarthria, stuttering, voice, and aphasia. Epidemiology the incidence of stuttering is reported to be 1% of the United States population with a 3:1 male to female ratio ( In addition, the speech and language pathologist will conduct an articulation evaluation to identify the type of error, such as distortion, omission or substitution. There are several standardized instruments that can quantify the degree of disorder. When a voice disorder is suspected, a physician should always be involved because of the possibility of serious health concerns. The physician will often use some sort of instrument (laryngeal mirror, for example) to examine the larynx and vocal folds. Fluency is evaluated by requesting the individual to read or speak, sometimes using stress producing tasks, such as speaking on the phone. An evaluation of fluency may also involve a thorough interview and the assessment of language skills. Children often experience a normal period of disfluency from the ages of two to four. A trained speech and language pathologist can identify risk factors, such as a family history of stuttering, prolonged period of stuttering, and whether there is concomitant speech and language disorder. The speech/language pathologist will first determine whether a significant problem exists. An evaluation for aphasia will often include examination by a number of medically related professionals, such as speech/language pathologists, doctors, nurses, neuropsychologists, occupational therapists, physical therapists, and social workers. The communication domains (listening, speaking, reading, writing, and social language) will be evaluated informally or formally, using standardized test instruments. S Evaluation Treatment Evaluation of speech articulation disorders first involves examination of the oral mechanism to determine whether the muscles and structures of the oral cavity are working the treatment of articulation disorders involves learning to recognize when the sound is produced correctly 2342 S Speech-Language Intervention Roseberry-McKibbon, C.

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This instrument is comprised of tasks read by the examiner and answered by the child; administration typically takes between 30 and 45 min. It generates four scores: raw scores, percentiles, quotients, and age equivalents. In addition, comprehension and application of conversational routines and skills are typically impaired. It is a screening measure that can be used to determine the need for further assessment of speech, syntax, semantics, coherence, pragmatic initiation, scripted language, context, nonverbal communication, social relations, and interests. Guidelines for speech-language pathologists in diagnosis, assessment, and treatment of autism spectrum disorders across the life span. Autism, primary pragmatic difficulties and specific language impairment: Can we distinguish them using psycholinguistic markers Neural correlates of pragmatic language comprehension in autism spectrum disorders. Current treatment practices include various forms of social skills training including individual one-on-one therapy and group therapies encompassing discussions, role playing, and problem-solving situations. These interventions target the comprehension of social situations as well as the application of effective language skills within the social situation. In addition, treatments can include peer modeling within the classroom or treatment session, parent education, and involvement. More recent treatment strategies involve video modeling to facilitate skill development. To meet criteria for dementia, the impairments must not occur exclusively in the context of a delirium, and must represent a decline from previously higher levels of functioning. Additionally, the impairments must be of sufficient severity to cause impairment in social or occupational functioning. In the late nineteenth and early twentieth centuries, senile dementia was thought to result from atherosclerosis of the brain blood vessels. Her symptoms consisted of delusions, memory impairment, apathy, and impairment in performing common tasks of daily living. She had difficulty finding objects, no longer understood the concept of money, and became increasingly suspicious of others. Her course was rapid, marked at times by nonsensical speech and periods of agitation and aggression. At the end of her illness, she was bedridden, exhibiting severe deterioration in all cognitive spheres. At autopsy, Alzheimer described generalized cerebral atrophy, atherosclerosis of the cerebral arteries, and neuronal alterations in the cortex that are now recognized as neurofibrillarly tangles and senile plaques (Lage, 2006). The age (65) to distinguish pre-senile dementia from senile forms was not based on any specific medical criteria, but presumably was selected in accordance to the age of qualification for old age insurance in Germany (Bick, 1994). Although most definitions recognize memory impairment as the cardinal feature, they are unsuitable for dementing illnesses where other symptoms predominate. More often than not, it refers to an age of dementia onset in late life, on or after age 65. Because it lacks specificity, the term ``senile dementia' is rarely used as a sole diagnosis, unless to designate a dementia of unknown cause. Fully formed senile plaques are characterized by a central beta-amyloid core and surrounded by elements of degenerating neurons (dystrophic neurites). Diffuse plaques, by contrast, are widely distributed in the brain, but lack the surrounding neurites. Figure 1 Senile plaques stained with a modified Bielschowsky silver stain (Photo courtesy of Steven S. Additional distinctions have been made between the terms ``sensitive' and ``critical' period. Fox (1970) suggested that the term ``critical period' be used when a specific environmental stimulus is needed to cue normal development, whereas the term ``sensitive period' be used to describe when the development is more easily influenced by a negative environmental event. The relative vulnerability of the developing fetus to teratogens during the first trimester is an example of a sensitive period (Spreen, Risser, & Edgell, 1995). Knudsen (2004) posited that ``critical' periods are a specific class of sensitive periods that involve permanent changes in functional brain development.

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The horse was sound and in regular work as a hunter when examined 13 months after surgery. The damaged carpometacarpal and interosseous ligaments identified in this horse had low signal intensity on the T2-w images, a finding typical of chronic injury. The low signal intensity of the ligamentous tissue was likely due to diffuse ligament fibre hypertrophy, replacing spaces normally filled with high signal intensity synovial fluid or vasculature. Previous reports have noted that a loss of normal fibre pattern of the transverse intercarpal ligament as well as osseous irregularity adjacent to the ligament was thought to be associated with lameness (Murray 2007; Nagy and Dyson 2011). In addition, decreased signal intensity of the third and fourth carpal and metacarpal bones was also identified adjacent to the injured ligaments. The low signal intensity in these areas corresponds to decreased bone marrow fat content, which is compatible with sclerosis (Anastasiou et al. Sclerosis may have developed secondary to chronic enthesopathy or osseous remodelling in response to chronic ligamentous instability. This osseous remodelling was likely the cause of the increased radiopharmaceutical uptake seen in the region of the fourth carpal bone on nuclear scintigraphy. It is not always possible to determine the cause of lameness localised to the carpus and proximal metacarpal region with clinical examination alone. In this horse, the scintigraphic finding of increased radiopharmaceutical uptake in the region of the fourth carpal bone and proximal metacarpal region supported the suspicion of injury to this region. Nuclear scintigraphy is exquisitely sensitive to lesions involving osseous remodelling; however, the lack of specificity of this imaging modality can limit its ability to direct treatment (Archer et al. In this horse, the initial diagnosis by the referring veterinarian was proximal suspensory desmopathy which was treated with palmar metacarpal fasciotomy and a controlled exercise rehabilitation programme. Typically, horses with forelimb proximal suspensory injuries have a good prognosis to return to performance when treated conservatively with rest and rehabilitation alone. Surgical management including plantar neurectomy and/or fasciotomy is usually reserved for desmopathy of the suspensory ligament in the hindlimb (Hewes and White 2006; Brokken et al. However, forelimb lameness caused by chronic proximal suspensory desmopathy, which is refractory to conservative management, has been recently reported to be successfully treated by neurectomy of the deep branch of the lateral palmar nerve (Gay Guasco et al. Based on the combination of abnormalities affecting the lateral aspect of the distal carpus and proximal metacarpal region, facilitated carpometacarpal arthrodesis was performed to promote fusion of the carpometacarpal joint. The surgical drilling technique used in this horse was a modification of the techniques described by Barber and Lang for horses with advanced carpometacarpal osteoarthritis (Barber et al. The drill bit was inserted in the carpometacarpal joint at 2 locations concentrating on the lateral aspect of the joint. As demonstrated in studies related to the fusion of the tarsometatarsal and distal intertarsal joints, bony ankylosis on radiographs does not always correlate directly with soundness (Dowling et al. However, it is important to note that a definitive cause of lameness may be difficult even with all the diagnostic and clinical information provided. Arthroscopy has been the traditional method of evaluation and treatment of intraarticular injuries; however, it requires general anaesthesia, not all parts of the joint can be accessed and the internal architecture of intra-articular structures cannot be evaluated (McIlwraith et al. Moreover, only the proximal two carpal joints can be examined arthroscopically; the carpometacarpal joint is completely inaccessible. These lesions have been associated with middle carpal joint effusion, intra-articular haemorrhage and lameness. However, the clinical significance has been questioned because in most cases other intra-articular lesions were also present or there were no signs of acute injury. The normal ultrasonographic appearance of the palmar intercarpal ligaments has been described (Driver et al. Osseous reactions at the insertion sites can also be seen on good quality low-field images (Nagy and Dyson 2012). Transverse intercarpal ligament injuries have been seen as a sole lesion associated with carpal pain in a small number of horses (Nagy and Dyson 2012). Diagnosis was primarily based on marked osseous reaction in the carpal bones at the ligament insertion sites.

References:

  • https://www.ojp.gov/pdffiles1/nij/grants/228091.pdf
  • https://www.guilford.com/excerpts/antony2.pdf
  • https://acnp.org/wp-content/uploads/2017/11/CH10_133-146.pdf