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By: William A. Weiss, MD, PhD

  • Professor, Neurology UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA

There is an accompanying diminution of sensibility due to generic 300mg retrovir overnight delivery raising of the sensory threshold (cf buy retrovir 300mg with mastercard. Hyperpathia is a feature of thalamic lesions order retrovir 300 mg amex, and hence tends to cheap retrovir 100mg with mastercard involve the whole of one side of the body following a unilateral lesion such as a cerebral haemorrhage or thrombosis. Generalized hyperpathia may also be seen in variant Creutzfeldt–Jakob disease, in which posterior thalamic (pulvinar) lesions are said to be a characteristic neuroradiological nding. Cross References Allodynia; Dysaesthesia; Hyperalgesia Hyperphagia Hyperphagia is increased or excessive eating. Binge eating, particularly of sweet things, is one of the neurobehavioural disturbances seen in certain of the frontotemporal dementias. Hyperphagia may be one feature of a more gen eral tendency to put things in the mouth (hyperorality), for example, in the Kluver–Bucy syndrome. Cross References Hyperorality; Kluver–Bucy syndrome Hyperphoria Hyperphoria is a variety of heterophoria in which there is a latent upward devi ation of the visual axis of one eye. Using the cover–uncover test, this may be observed clinically as the downward movement of the eye as it is uncovered. Cross References Cover tests; Heterophoria; Hypophoria Hyperpilaphesie the name given to the augmentation of tactile faculties in response to other sensory deprivation, for example, touch sensation in the blind. This may be physiological in an anxious patient (re exes often denoted ++), or pathological in the context of corticospinal pathway pathology (upper motor neurone syn drome, often denoted +++). It is sometimes dif cult to distinguish normally brisk re exes from pathologically brisk re exes. Hyperre exia (including a jaw jerk) in isolation cannot be used to diagnose an upper motor neurone syndrome, and asymmetry of re exes is a soft sign. On the other hand, upgoing plantar responses are a hard sign of upper motor neurone pathology; other accom panying signs (weakness, sustained clonus, and absent abdominal re exes) also indicate abnormality. This may be due to impaired descending inhibitory inputs to the monosynaptic re ex arc. Rarely pathological hyperre exia may occur in the absence of spasticity, suggesting different neuroanatomical substrates underlying these phenomena. Hyper-re exia without spasticity after unilateral infarct of the medullary pyramid. It may be encountered along with hypergraphia and hyposexuality as a feature of Geschwind’s syndrome. It has also been observed in some patients with frontotemporal dementia; the nding is cross-cultural, having been described in Christians, Muslims, and Sikhs. In the context of refractory epilepsy, it has been associated with reduced volume of the right hippocampus, but not right amygdala. Religiosity is associated with hip pocampal but not amygdala volumes in patients with refractory epilepsy. Cross References Hypergraphia; Hyposexuality Hypersexuality Hypersexuality is a pathological increase in sexual drive and activity. Recognized causes include bilateral temporal lobe damage, as in the Kluver–Bucy syndrome, septal damage, hypothalamic disease (rare) with or without subjective increase in libido, and dopaminergic drug treatment in Parkinson’s disease. Sexual disinhibition may be a feature of frontal lobe syndromes, particularly of the orbitofrontal cortex. Cross References Disinhibition; Frontal lobe syndromes; Kluver–Bucy syndrome; Punding Hypersomnolence Hypersomnolence is characterized by excessive daytime sleepiness, with a ten dency to fall asleep at inappropriate times and places, for example, during 187 H Hyperthermia meals, telephone conversations, at the wheel of a car. Clinical signs may include a bounding hyperdynamic circulation and sometimes papilloedema, as well as features of any underlying neuromuscular disease. Sleep studies con rm nocturnal hypoventilation with dips in arterial oxygen saturation. Cross References Asterixis; Cataplexy; Papilloedema; Paradoxical breathing; Snoring Hyperthermia Body temperature is usually regulated within narrow limits through the coor dinating actions of a centre for temperature control (‘thermostat’), located in the hypothalamus (anterior–preoptic area), and effector mechanisms (shiver ing, sweating, panting, vasoconstriction, vasodilation), controlled by pathways located in or running through the posterior hypothalamus and peripherally in the autonomic nervous system. Other recognized causes of hyperthermia include • Infection: bacteria, viruses (pyrogens. It usually implies spasticity of corticospinal (pyramidal) pathway origin, rather than (leadpipe) rigidity of extrapyramidal origin. Depending on the affected eye, this nding is often described as a ‘left-over right’ or ‘right-over left’. Cross References Bielschowsky’s sign, Bielschowsky’s test; Cover tests; Heterotropia; Hypotropia Hypoaesthesia Hypoaesthesia (hypaesthesia, hypesthesia) is decreased sensitivity to, or diminu tion of, sensory perception in any modality, most frequently used to describe pain (hypoalgesia) or touch. Cross Reference Anaesthesia Hypoalgesia Hypoalgesia is a decreased sensitivity to, or diminution of, pain perception in response to a normally painful stimulus. Repeated apposition of nger and thumb or foot tapping may be useful in demonstrated hypokinesia of gradual onset (‘fatigue’). It may often coexist with bradykinesia and hypometria and is a feature of disorders of the basal ganglia (akinetic-rigid or parkinsonian syndromes), for example: • Parkinson’s disease • Multiple system atrophy • Progressive supranuclear palsy (Steele–Richardson–Olszewski syndrome) • Some variants of prion disease Cross References Akinesia; Bradykinesia; Fatigue; Parkinsonism Hypometria Hypometria is a reduction in the amplitude of voluntary movements. It may be demonstrated by asking a patient to make repeated, large amplitude, opposition movements of thumb and fore nger, or tapping movements of the foot on the oor. Voluntary saccadic eye movements may also show a ‘step’, as a correcting additional saccade compensates for the undershoot (hypometria) of the original movement. Hypometria is a feature of parkinsonian syndromes such as idiopathic Parkinson’s disease. Cross References Akinesia; Bradykinesia; Dysmetria; Fatigue; Hypokinesia; Parkinsonism; Saccades Hypomimia Hypomimia, or amimia, is a de cit or absence of expression by gesture or mimicry. This is usually most obvious as a lack of facial expressive mobility (‘mask-like facies’). Cross References Facial paresis, Facial weakness; Fisher’s sign; Parkinsonism Hypophonia Hypophonia is a quiet voice, as in hypokinetic dysarthria. Cross References Dysarthria; Dysphonia; Parkinsonism Hypophoria Hypophoria is a variety of heterophoria in which there is a latent downward deviation of the visual axis of one eye.

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An existing schema 1 represents the sum of an individual’s current state of knowledge and understanding of the 2 particular topic buy cheap retrovir 300mg on line, event order retrovir 100mg amex, action and so on generic 300 mg retrovir visa. New learning concerned with the particular topic will 3 involve the processes of accommodation and assimilation 300 mg retrovir overnight delivery, and the expansion and increase in 4 complexity of the schema in question. For this reason, it is very important that a schema that 5 is to be the focus of these processes in the introduction of a new area of work in school is 6 activated at the outset of a new topic, and reactivated each time the learning is to move on in 7 subsequent lessons. In simple terms, if new learning is to take place, it is a very good idea to 8 review what is already known about the topic in question. The starting point of what is already 9 known and understood is very important if any new learning is to be effective. Schema activation 30 is a process which can be encouraged in classroom situations, and teachers frequently make use 1 of this idea in their work. It is estimated 8 that any adult would have hundreds of thousands of schemas in memory, which would be 9 interrelated in an extremely large and complex number of different ways. This creating and updating takes 41 22 Ways of learning place every time that we read, listen to, observe, try out or sense in any other way anything 1 new. New schemas are created every time that one fact is linked to another by a logical or 2 semantic connection. Each schema is a sub-schema of another larger and related schema, and 3 each schema has set of sub-schemas of its own. This description gives an 18 image of a child alone, exploring the immediate environment, and drawing conclusions about 19 the nature and structure of the world. Social constructivism adds an important dimension to 20 the constructivist domain. In social constructivist theory, emphasis is placed upon interaction 1 between the learner and others. The others can come in many forms – it is the dimension of 2 social interaction that is crucial to the social constructivists. The main proponents of this branch 3 of constructivism are Vygotsky, a Russian whose work was carried out at the start of the 4 twentieth century but not widely available in the West until many years later; and Bruner, an 5 American publishing his work in the second half of the twentieth century. Dialogue becomes the vehicle by which ideas are considered, shared and 8 developed. The dialogue is often with a more knowledgeable other, but this need not always 9 be the case. It is an individual’s prior and current knowledge that forms the basis of any contribution 1 to a dialogue. It is with reference to existing knowledge and understanding (schemas) that new 2 ideas and understanding can be constructed in the course of dialogue. When we consider the 3 more knowledgeable other, it is easy to assume that this person will be a teacher or a parent, 4 but this need not be the case. More knowledgeable need not imply older nor in a position of 5 responsibility for learning. It is very often the case that learning will take place in very different 6 environments. The building and exchange of thoughts and ideas which takes 8 place in the course of a discussion, in any context at all, is likely for at least one of the 9 participants, and often for both or all of them, to lead to a greater understanding of, or insight 40 into, the topic of the conversation. In a very real way, the teacher engages groups and individuals in dialogue and supports the development of understanding. The undertaking of this role, in a planned way, has a particular name and is known as ‘scaffolding’. The zone of proximal development is a refreshingly simple description of something which many teachers and other adults understand and work with. It is an idea fromVygotsky’s work which has impacted on practice over the last 20 years or so as more importance has been given to the notion of differentiation in teaching. The zone of proximal development is a theoretical space of understanding which is just above the level of understanding of a given individual. In the zone of proximal development, a learner is able to work effectively, but only with support. The process of learning involves moving into and across the zone and looking forward to the next level of understanding, which will involve a similar journey through a newly created zone. Sewell (1990) explains it as ‘a point at which a child has partly mastered a skill but can act more effectively with the assistance of a more skilled adult or peer’. Passing through the zone of proximal development is a process which can be aided by the intervention of another. In planning work for children, a teacher needs to take into account the current state of the understanding of the children in question, and plan accordingly and appropriately. Scaffolding is the process of giving support to learners at the appropriate time and at the appropriate level of sophistication to meet the needs of the individual. Scaffolding can be presented in many ways: through discussion – a good socially constructive approach; through the provision of materials – perhaps supplying practical apparatus to help in the solution of simple problems in arithmetic; or by designing tasks which match and give help appropriate to the individual – a list of words given to help in the process of completing an exercise designed to assist understanding, or a list of reminders concerning the process of undertaking the task in question; a writing frame to support a particular style of written piece is also an example. Working collaboratively, in pairs or small groups, is an obvious socially constructive approach to learning. The converse of this would be working in a silent classroom, where contact with others is discouraged. There are times when quiet individual working is useful and important, and teachers are able to describe times when a child should be encouraged to work quietly and alone. As a mainstay approach to teaching and learning, this would totally ignore all that we know about socially constructed learning. If the context is unfamiliar to the learner, learning will 4 not necessarily proceed smoothly. Another aspect of situated learning, which is more relevant 8 here, is the notion that learning can be situated in social and cultural settings, and that if a 9 learning activity falls beyond the cultural understanding of the learner then learning is likely, 10 at best, to be less successful than if it had been situated in a more familiar setting. For example, 11 giving young children the task of investigating the pros and cons of fox-hunting when their 12 cultural setting is a deprived inner-city area where contact with the countryside, with animals, 13 domestic or wild, and the emotions associated with the discovery of ravaged lambs or roosting 14 hens are alien to them, is very unlikely, without exceptionally detailed and sympathetic 15 introductions and the provision of first-hand experience, to lead to good quality learning 16 experiences.

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Typically buy retrovir 300mg with visa, visually in spite of intact semantic knowledge for example cheap retrovir 300 mg on line, cells in your fovea (central eld of of them buy 300mg retrovir overnight delivery. Reinforcement: typically some form of reward Paralysis: loss of movement in a body region (such (positive reinforcement) or punishment (nega as a limb) retrovir 100 mg without a prescription. It plays key Reinforcer: a stimulus that elicits a change in roles in spatial function and attention. Parkinson’s disease: a neurological disorder in Retrograde amnesia: a form of memory loss where which movements become slowed or are lost people are unable to remember events that altogether. Associated with loss of cells in and around the Reward: in animal learning, anything that an basal ganglia. Parkinsonism: signs and symptoms that resemble Sagittal: sideways, as in sagittal brain scans taken Parkinson’s disease. Perseveration: the tendency to repeat the same (or Signal to noise ratio: degree to which relevant similar) response despite it no longer being information can be perceived against a back appropriate. Perseverative (see above): a response may be per Signs: the indications of some abnormality or dis severative in the sense of being an unnecessary turbance that are apparent to the trained or inappropriate regurgitation of an earlier clinician/observer (as opposed to symptoms, response. Glossary 337 Simultanagnosia: inability to recognise multiple Syntax: the rules governing the structure of elements in a simultaneously displayed visual sentences. Tachistoscope: an item of psychological equipment Somatosensory: sensation relating to the body’s with which visual material can be presented to super cial and deep parts, as contrasted to respondents for very brief exposure times (these specialised senses such as sight. Spatial neglect: a condition in which damage to one Telegraphic speech: a name to describe the non side of the brain causes a de cit in attention to uent “stop–start” agrammatic speech associ the opposite side of space. Speech apraxia: a characteristic sign of Broca’s Temporal lobe: the region of the cortex (on both aphasia in which articulatory problems are sides of the brain) running forward horizontally apparent and speech is peppered with above and in front of the ear, known to be neologisms or paraphasias. Most commonly, Thalamus: a multi-functional subcortical brain strokes are caused by obstruction to, or rupture region. Theory of mind: the ability to attribute mental Striatum: a collective name for the caudate and states to others and to understand that others putamen, key input regions in the basal have beliefs that are di erent from one’s own. Transduction: process by which a cell converts one Subcortical: the portion of the brain immediately kind of signal or stimulus into another. A genetic cause of nigra terminate in the striatum, where they neurological disorders. Ultrasound: an antenatal procedure for generating Sulci: the smaller folds or indents on the surface of images of unborn children. Typically 20–30 nanometres (millionths Working memory: a form of short-term memory, of a millimetre) wide. Deep brain stimulation for refractory between left handed and right handed men: obsessive-compulsive disorder. Journal of relationships between temporal lobe Cognitive Neuroscience, 14, 1264–1274. Journal of Advances in Clinical Neuroscience and Cognitive Neuroscience, 16, 453–462. Trends in Cognitive myasthenia gravis: Electrophysiological and Sciences, 10, 455–463. Reorganisation of Non-reconnaissance d’animaux familiers chez somatosensory area 3b representation in adult un paysan: Zooagnosie ou prosopagnosie pour owl monkeys after digit syndactyly. Executive memory: A proposed system and its control function and the frontal lobes: A meta analytic processes. Neglect and anosognosia after Brain, conscious experience and the observing rst-ever stroke: Incidence and relationship to self. E ects of task Brain activation in young older adults during requirements on ear superiority for sung implicit explicit retrieval. Philosophical Transactions of the Journal of Cognitive Neuroscience, 9(5), Royal Society (B): Biological Sciences, 356, 664–686. Behavioural Research acquire new semantic knowledge in patients and Therapy, 31, 731–737. The essential di erence: somatic marker hypothesis: Some questions the truth about the male and female brain. Speech production after stroke: the role neural correlates in visual agnosia after of the right opercularis. Lateralised processing of during the observation of touch and a case positive facial emotion: Sex di erences in of touch–vision synaesthesia. Trends in Cognitive and connotative word meaning by brain Sciences, 9(10), 489–495. Withdrawing hemisphere contributions to lexical semantics attention at little or no cost: Detection and (pp. Annual Neural mechanisms of transient and sustained Review of Neuroscience, 27, 723–749. Remarques sur la siege de la function in experimental and clinical faculte du langage articule. Lokalisationslehreder Grosshirnrinde in ihren the role of the rostral frontal cortex (area 10). Journal of for planning hand–object interactions in Cognitive Neuroscience, 10, 1–34. Relevance of functional imaging in the Dynamics of visual recognition revealed by progression of mild cognitive impairment. Degeneration and of the neural correlates of language and regeneration of the nervous system [R. Journal of precuneus: A review of its functional anatomy Comparative Neurology, 435, 406–417. Functional relevance of cross-modal anterograde retrograde retrieval ability of a plasticity in blind humans.

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Using voice-visualization in therapeutic sessions may also involve one major advantage over traditional therapeutic sessions that only involve a therapist retrovir 300mg mastercard. This advantage is that a voice-to-vision application may possibly be more engaging and appealing to cheap retrovir 300mg on line the patient than a face-to-face session with a therapist discount retrovir 100mg on-line. The next section highlights the need for gathering a rich set of requirements and preferences for creating voice-controlled applications that are accessible and engaging to order 100mg retrovir free shipping the deaf. Furthermore, many existing strategies for conveying these characteristics and teaching the deaf how to perceive them do not seem efficient, especially when dealing with the concept of pitch. As a result, some deaf people are not fully capable of differentiating between voice characteristics and some cochlear implant recipients “often confuse the concept of pitch with loudness” [Fearn, 2001]. Paradoxically, this does not only apply to the deaf, but some of the hearing cannot make a clear distinction between the concepts of pitch and loudness [Ma, 2001]; when asked to generate a higher-pitched sound, many generate a louder sound, which may of course be a linguistic rather than a cognitive confusion. These were some of the many reasons that led to my exploration of additional approaches to the visual representation of voice. I employed SpitSplat and Expressmas Tree in analyzing the interaction patterns of seven deaf children. I slightly modified the screen version of Expressmas Tree to test it on deaf users. The aim was to explore the potential role of paralinguistic vocal control of interactive media in enabling the deaf to have a greater understanding of voice and to offer their instructors more efficient and engaging strategies for explaining voice characteristics. There are many reasons why non-speech voice-controlled games could be useful to the deaf as well as to the hearing. According to Goberis and Loraine “Most young children, whether implant users or not, tend to use a voice that is too loud” [Goberis and Loraine, 2006]. As a result, several loudness charts have been designed to aid the deaf in learning the variations between loud and soft voices. These usually contain a small figure representing a soft sound, a medium figure representing a medium sound, and a larger figure representing a loud sound. However, there are hardly any well-designed charts that establish an understanding of pitch or duration. Moreover, charts are unlikely to be as engaging, appealing and memorable as an interactive experience. Figure 81: An illustration of a star was employed as a visual feedback signal in the virtual version of Expressmas Tree. The evaluation involved observing, writing field-notes, and video-recording seven children with varying degrees of hearing loss that ranged from mild (hearing threshold => 25 dB) to profound (hearing threshold => 95 dB). I started with Zahra, a seven-year-old female (mild hearing loss) who had a cochlear implant. The instructor, Afrah Al Fardan, was present during the study to help in instructing the children. I started by demonstrating how to play SpitSplat by uttering ‘ooh’ into the microphone. She produced an air stream by blowing on her hand and instructed Zahra to avoid doing so. She then placed Zahra’s hand on her own throat, generated an ‘ooh’ sound, and explained that that was the right way to play the game. Placing Zahra’s hand on her instructor’s throat allowed her to sense the vibration of the instructor’s vocal folds. She immediately realized that she was expected to produce a voiced sound rather than a voiceless air-stream. Zahra, however, seemed too shy to generate a loud voice and was therefore not very willing to vocalize in the presence of an invigilator. Despite receiving instructions to vocalize louder, Zahra was still either blowing into the microphone or producing a very soft ‘ooh’. This led the instructor to demonstrate how to light the sequence of bulbs and stop at the flashing bulb by uttering a prolonged ‘Paaaa’. This vocal expression seemed to be more convenient because unlike ‘ahh’ or ‘ooh’, it started with the bilabial (lips touch each other) consonant ‘P’. Seeing the lips come together enabled Zahra to ‘see’ the onset of voice, which turned out to be an important factor as duration was the voice characteristic in question. Due to Zahra’s shyness and the time it took to explain the game-play to her, it was decided that user-testing all the participants together in one room rather than singularly would be more efficient and encouraging. I invited the other six participants and the instructor explained and demonstrated Expressmas Tree. Explaining that they should stop vocalizing upon reaching a flashing bulb was a very difficult task. Four of them seemed to have eventually realized it, while the rest confined themselves to watching how the bulbs lit sequentially as a visual reaction to their vocal input. One of the remarkable behaviors that I observed was that Hussain, a five-year old male (mild hearing loss), who wore a hearing aid, tapped the floor with his foot while vocalizing (Figure 83). It seemed (to the instructor) that he performed this complementary behavior either to help him prolong his vocalization, or to help him estimate the required duration by synchronizing his tapping with the sequential lighting of the bulbs. Another interesting behavior was that Abdullah, a six-year-old male (mild hearing loss), who wore a hearing aid, insisted on vocalizing or pointing at the flashing bulb while others played in order to help them. I also noticed Ali, who was a three and a half-year-old male (mild hearing loss) with a cochlear implant, blocking his ears. Ahmed, on the other hand, who was a four year-old male (profound hearing loss), with a cochlear implant, seemed to have clearly understood the game.

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