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F. Felipe. Granite State College.

It appears then buy discount altace 2.5 mg blood pressure reading 400, according to parents order altace 5mg amex blood pressure medication good for kidneys, that the majority of siblings helped in some way with caring needs of their disabled brother or sister. According to 16 siblings interviewed, all said they helped their family with differing types of caring tasks. The nature of those responsibilities will now be explained in more detail. Relieving the stress experienced by parents Siblings may help by taking pressure off their parents. Siegal and Silverstein (1994) also identified that when children take on a parental role they reduce the stress experienced by the main carers, usually the parents. Through being a care-giver as well as a son or daughter the child forms an alliance with their parents which, according to Mayhew and Munn (1995), gives them added status within the family. CHILDREN AS YOUNG CARERS / 71 In interview, with a girl I shall call Katy, aged 13, she recalled how she would assist her parents, by reading a story to her brother as part of his bedtime routine. Another girl, Jackie, aged 14, acknowledged that she thought it part of her responsibility to take the pressure off her parents by giving her brother her attention, thereby diverting his demands away from both parents. Chris, aged 14, would play with his sister, Mary, who had ‘autistic tendencies’ and would usually suffer his hair being pulled, but would not react by shouting or showing any indication of pain, having discovered that reacting encouraged more hair pulling. He never discussed this with his parents because ‘they had enough to worry about’. He helped his parents by keeping his sister occupied, tolerating her behaviour in a way he would never accept from his friends and by not telling his parents about the stress Mary caused him. The motivation to take on the role as helper may not therefore be to gain parental approval; it may be an acceptance of one’s situation within the family. The problem is that such encounters may well instil a sense of guilt at having similar abilities to most other children, a fact which others would never question. These examples demonstrate a form of disability by association, acceptance perhaps, from which ‘young carers’ would normally exclude their parents, but would ‘only tell’ because of ‘the research interview’. A further insight, one that helps to explain the reticence of siblings to express their opinions, is offered by Bank and Kahn (1982), who point out that, when one sibling is viewed as disabled, the non-disabled sibling will try and refrain from aggressive behaviour. The difficulty associated with this apparent ‘good behaviour’ is that the spontaneity of child play, including ‘messing about’, will be inhibited (Ibid. Siblings may also be ashamed of or embarrassed by their disabled sibling and learn not to speak out, rather keeping their views to themselves, as this review 72 / BROTHERS AND SISTERS OF CHILDREN WITH DISABILITIES has demonstrated. Consequently, it is not too surprising when Powell and Ogle (1985) note that siblings may feel confused about their role within the family, for they are both sibling and carer, playmate and responsible person, but without the maturity of an adult. Life restrictions In a survey carried out by Atkinson and Crawford (1995) for NCH Action for Children, seven out of ten children surveyed said their caring responsi- bilities placed restrictions on their lives. Richardson (1999), a brother with a disabled sister, could not remember being cared for himself; as he put it, ‘ I don’t much recall being looked after’. His family had to focus on the needs of his disabled sister, as he did himself. The consequences of having a disabled sibling are not all positive and I note adverse aspects too: for example, Janet aged 13, who has a sister with disabilities, said, ‘I really do love my brothers and sister but they get so annoying I feel like crying’ (Burke and Montgomery 2001b, p. Powell and Ogle (1985) suggest that siblings may feel confused about their role in the family, being both sibling and ‘surrogate parent’. Furthermore, it is likely that siblings will not experience an equal freedom to go through the usual processes of childhood and adolescence, as experienced by non-disabled families, a process which, arguably, is the right of childhood. If sibling caretakers are denied both their childhood and their adolescence, it is likely that their needs will remain unmet and these require some attention during their experiences of carrying additional responsibilities for their disabled brothers or sisters. Siblings with disabled brothers and sisters must first and foremost, be understood, and for that to happen, someone has to listen, and parents, as I have shown, are not always available to do so. CHILDREN AS YOUNG CARERS / 73 These illustrations, research findings and examples indicate the need for sibling support. Siblings of disabled brothers and sisters have a right not to talk about their feelings in the family. Indeed, some siblings do not seem aware that they have a right to their parents’ time with the family focus being on the needs of the disabled child and the needs of other family members taking second place.

These edited videotape presentations are on the skull and the brain as the material would be shown to students in CD-ROMS the gross anatomy laboratory generic altace 5 mg overnight delivery hypertension dizziness. They have been prepared with the same teaching orientation as this atlas and are Numerous CDs are appearing on the market cheap altace 2.5mg online blood pressure chart male, and their particularly useful for self-study or small groups. These evaluation by the teaching faculty is critical before rec- videotapes of actual specimens are particularly useful for ommending them to learners. In addition, several of the students who have limited or no access to brain specimens. It is indeed a difficult task to obtain and review 20–25 minutes. A listing of the CD-ROMs available can be viewed on the Web site Neuroanatomy and Neuropathology on INTERIOR OF THE SKULL the Internet (above) — see http://www. This program includes a detailed look at the bones of the skull, the cranial fossa, and the various foramina for the The following has been reviewed: cranial nerves and other structures. Included are views of the meninges and venous sinuses. Brainstorm: Interactive Neuroanatomy By Gary Coppa and Elizabeth Tancred, Stan- THE GROSS ANATOMY OF THE HUMAN BRAIN SERIES ford University A highly interactive and well-integrated cross- Part I: The Hemispheres linked presentation of the anatomy and some A presentation on the hemispheres, the func- functional aspects of the nervous system. Louis, MO, Part II: Diencephalon, Brainstem, and Cerebellum 63146-9934. A detailed look at the brainstem, with a focus on © 2006 by Taylor & Francis Group, LLC . ATLAS OF FUNCTIONAL NEUROA NATOMY SECOND EDITION © 2006 by Taylor & Francis Group, LLC © 2006 by Taylor & Francis Group, LLC ATLAS OF FUNCTIONAL NEUROA NATOMY SECOND EDITION Walter J. Boca Raton London New York A CRC title, part of the Taylor & Francis imprint, a member of the Taylor & Francis Group, the academic division of T&F Informa plc. Government works Printed in the United States of America on acid-free paper 10987654321 International Standard Book Number-10: 0-8493-3084-X (Softcover) International Standard Book Number-13: 978-0-8493-3084-1 (Softcover) Library of Congress Card Number 2005049418 This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequences of their use. No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Hendelman, Walter. Atlas of functional neuroanatomy / Walter Hendelman. To my wife and life partner, Teena and to our daughter, Lisanne and sadly now to the memory of our daughter, Devra To the many teachers and mentors and colleagues in my career as a neuroscientist, and particularly with respect and gratitude to Dr. Malcolm Carpenter To all those students, staff, and colleagues who have assisted me in this endeavor and to all the students who have inspired me in this learning partnership. As a teacher, it is my conviction that each slide or picture that is shown to students should be accompanied by an explanation; these explanations formed the basis of an atlas. Diagrams were created to help students understand the structures and pathways of the nervous system and each illustration was accompanied by explanatory text, so that the student could study both together. The pedagogical perspective has not changed over the various editions of the atlas as it expanded in content, but the illustrations have evolved markedly. They changed from simple artwork to computer-based graphics, from no color to 2-color, to the present edition in full color. The illustrations now include digital photographs, using carefully selected and dissected specimens. Most of the diagrams in the atlas were created by medical students, with artistic and/or technological ability, who could visualize the structural aspects of the nervous system. These students, who had completed the basic neuroanatomy course, collaborated with the author to create the diagrams intended to assist the next generation of students to learn the material more easily and with better understanding.

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The left hemisphere is specialized for speech purchase altace 10mg online prehypertension vitamins, writing purchase altace 2.5 mg mastercard blood pressure medication and fruit juice, APHASIA Disturbance in language comprehension or produc- language and calculation; the right hemisphere is specialized tion, often as a result of a stroke. CHOLECYSTOKININ A hormone released from the lining of the 48 stomach during the early stages of digestion which acts as a DRUG ADDICTION Loss of control over drug intake or compul- powerful suppressant of normal eating. It also is found in the sive seeking and taking of drugs, despite adverse consequences. ENDOCRINE ORGAN An organ that secretes a hormone directly CIRCADIAN RHYTHM A cycle of behavior or physiological into the bloodstream to regulate cellular activity of certain change lasting approximately 24 hours. CLASSICAL CONDITIONING Learning in which a stimulus that ENDORPHINS Neurotransmitters produced in the brain that naturally produces a specific response (unconditioned stimu- generate cellular and behavioral e∑ects like those of morphine. As a result, the conditioned stimulus can evoke a which are caused by abnormal excitation of large groups of response similar to that of the unconditioned stimulus. Epilepsy can be treated with COCHLEA A snail-shaped, fluid-filled organ of the inner ear many types of anticonvulsant medications. They are responsible for female CONE A primary receptor cell for vision located in the retina. The cone is sensitive to color and used primarily for daytime EVOKED POTENTIALS A measure of the brain’s electrical activ- vision. This is obtained by placing CORPUS CALLOSUM The large bundle of nerve fibers linking electrodes on the surface of the scalp (or more rarely, inside the left and right cerebral hemispheres. DEPRESSION A mental disorder characterized by depressed FOLLICLE-STIMULATING HORMONE A hormone released by the mood and abnormalities in sleep, appetite and energy level. Along male and growth of the follicle (which produces the egg) in with the cell body, it receives information from other neurons. DOPAMINE A catecholamine neurotransmitter known to FOREBRAIN The largest division of the brain, which includes have multiple functions depending on where it acts. The forebrain is cred- Dopamine-containing neurons in the substantia nigra of the ited with the highest intellectual functions. Dopamine is thought to regulate occipital) of each hemisphere of the cerebral cortex. The emotional responses and play a role in schizophrenia and frontal lobe has a role in controlling movement and in the drug abuse. DORSAL HORN An area of the spinal cord where many nerve GAMMA-AMINO BUTYRIC ACID (GABA) An amino acid trans- fibers from peripheral pain receptors meet other ascending mitter in the brain whose primary function is to inhibit the and descending nerve fibers. MANIA A mental disorder characterized by excessive excite- GLUTAMATE An amino acid neurotransmitter that acts to ment, exalted feelings, elevated mood, psychomotor over- excite neurons. Glutamate stimulates N-methyl-D-aspartate activity and overproduction of ideas. It may be associated (NMDA) receptors that have been implicated in activities with psychosis; for example, delusions of grandeur. Melatonin a∑ects lation of NMDA receptors may promote beneficial changes, physiological changes related to time and lighting cycles. GROWTH CONE A distinctive structure at the growing end of METABOLISM The sum of all physical and chemical changes most axons. It is the site where new material is added to the that take place within an organism and all energy transforma- axon. HIPPOCAMPUS A seahorse-shaped structure located within MIDBRAIN The most anterior segment of the brainstem. They play a role MITOCHONDRIA Small cylindrical particles inside cells that in sexual development, calcium and bone metabolism, growth provide energy for the cell by converting sugar and oxygen and many other activities. HUNTINGTON’S DISEASE A movement disorder caused by MONOAMINE OXIDASE (MAO) The brain and liver enzyme that death of neurons in the basal ganglia and other brain regions. HYPOTHALAMUS A complex brain structure composed of MOTOR NEURON A neuron that carries information from the many nuclei with various functions. These include regulating central nervous system to muscle. Symptoms include muscular weakness and progressively that prevents the recipient cell from firing. The disease’s cause is unknown IONS Electrically charged atoms or molecules. NERVE GROWTH FACTOR A substance whose role is to guide LONG-TERM MEMORY The final phase of memory in which neuronal growth during embryonic development, especially information storage may last from hours to a lifetime.

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Respiratory failure also shortens the life span of children with SMA2 generic altace 2.5 mg mastercard blood pressure extremely low, although not as early as in SMA1 purchase altace 2.5 mg without prescription blood pressure up heart rate down. SMA3 patients survive to adulthood and typically maintain ambulatory function. References Dubowitz V (1995) Disorders of the lower motor neurone: the spinal muscular atrophies. Saunders, London, pp 325–369 Wang CH, Carter TA, Gilliam TC (1997) Molecular and genetic basis of the spinal muscular atrophies. In: Rosenberg RN, Pruisner SB, DiMauro S, Barchi RL (eds) The molecular and genetic basis of neurological disease, 2nd edn. Butterworth-Heinemann, Boston, pp 787– 796 447 Poliomyelitis Genetic testing NCV/EMG Laboratory Imaging Biopsy + +++ + Poliomyelitis is a viral infection that causes the death of motor neurons in the Anatomy spinal cord and brainstem. During the acute phase of the infection, the virus may infect the cortex, thalamus, hypothalamus, reticular formation, brainstem motor and vestibular nuclei, cerebellar nuclei, and motor neurons of the anterior and lateral horns of the spinal cord, causing an inflammatory reaction. Death of motor neurons may result, leading to muscle atrophy. The motor neurons that survive recover fully and may reinnervate denervated muscle. Paralytic poliomyelitis is characterized by an initial period of muscle pain and Symptoms spasms, followed by muscle weakness that peaks in severity by one week after the onset of symptoms. Patients do not experience sensory impairment, but may complain of paresthesias. Bulbar symptoms occur in some patients and include dysphagia, dysarthria, hiccups, and respiratory weakness leading to anxiety and restlessness. In adults, bulbar disease is found in conjunction with spinal disease, but children (espe- cially those without tonsils or adenoids) may present with a pure bulbar poliomyelitis. Patients may also com- plain of neck and back stiffness and pain, from meningeal inflammation. Muscle weakness is asymmetric and typically proximal. Lumbar segments are Signs usually more severely affected, with trunk muscles being largely spared. Ten- don reflexes may be initially brisk, but become diminished or absent. Muscles progressively and permanently atrophy over a period of 2–3 months. Loss of bulbar motor neurons occurs in some patients and can lead to paralysis of the facial muscles (unilaterally or bilaterally), pharynx, larynx, tongue, and mastication muscles. If infection strikes the reticular formation, severe respiratory and autonomic impairment may result. Breathing and swallowing difficulties, as well as loss of vasomotor control, are serious risks for mortality and warrant intensive life support. Pathogenesis Acute poliomyelitis is caused by infection with one of three forms of entero- Acute poliomyelitis virus, a single-stranded, encapsilated RNA virus in the picornavirus family. Rare cases have been attribut- 448 ed to live attenuated virus in the polio vaccine. The replication phase takes place 1–3 weeks post-infection in the pharynx and lower gastrointestinal tract. Secretion of the virus occurs in the saliva and feces. The severity of infection is variable, and can be classified into several categories: Minor or abortive Most patients (95%) are asymptomatic, or exhibit pharyngitis or gastroenteritis. Non-paralytic or pre- Nervous system involvement is preceded by a flu-like set of symptoms, includ- paralytic poliomyelitis ing fever, headache, muscle aches, pharyngitis, anorexia, nausea, and vomit- ing. Neurological signs and symptoms include restlessness, irritability, and signs of meningitis (back/neck stiffness, Brudzinski and Kernig signs). This situation may then proceed to paralytic poliomyelitis. Paralytic poliomyelitis Paralytic poliomyelitis develops in only 1–2% of infected patients, anywhere from 4 days to 5 weeks following initial infection. Factors believed to predis- pose a patient to paralytic disease include muscle damage from recent strenu- ous exercise or muscle injections, increased age, tonsillectomy, weakened B-cell function, and pregnancy. Acute paralytic poliomyelitis causes fatal respi- Fig.

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