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In even take up employment buy zyloprim 300 mg cheap, whereas others are completely patients with hemiparesis, the affected side can read- helpless, reliant on outside help and care, and are unable ily be compared with the healthy side, which explains to communicate (⊡ Fig. In our experience, why sensory disorders are so well known in connection the slightly disabled cases are, unfortunately, the excep- with this distribution of neurological symptoms. Since the brains of these patients these problems also apply to cerebral palsy patients with is globally damaged, functional disorders in various areas differing topical distribution patterns. Intelligence is more diminished the with diplegia, not infrequently show sensory problems more severely disabled the patient. The actual damage to on closer examination, while patients with tetraparesis the brain is just one factor. As a result of the motor and sometimes refuse to wear shoes, or even socks, or else sensory problems, the children are also handicapped in they avoid placing their feet on the floor, which also sug- their mental development. Such sensory disorders may also be responsible for the weight-bearing problems that occasionally arise after corrective cast treatments. The defective speech and lack of cooperation exhib- ited by severely disabled patients often renders detailed examination of the sensory function impossible. The brain functions of severely disabled patients are often affected generally, resulting in additional disorders of the nervous system, e. These additional problems interfere considerably with the patients func- tioning and thus the rehabilitation. If proprioception is impaired, as is the case with many cerebral palsy patients, intact vision is all the more important by way of compensation. Unfortunately visual function, in particular, is impaired in up to 67% of pa- tients. Since the frequency of refraction anomalies is no more common than in neurologically health indi- viduals, the existence of a central visual disorder must be assumed. This also explains why patients can develop adequate balance control only with some dif- ficulty. They feel insecure in this position, becoming stressed as a result of having to guard against falls. But every stress leads to an increase in muscle tone, which further restricts the patient’s reactions.

But the data on painful phantoms below the level of total spinal section (Melzack zyloprim 100mg on-line, 1989, 1990) indicate that we need to go above the spinal cord and into the brain. Now let us make it clear that we mean more than the spinal projection areas in the thalamus and cortex. These areas are important, of course, but they are only part of the neural processes that underlie perception. The cortex, Gybels and Tasker (1999) made amply clear, is not the pain center and neither is the thalamus. The areas of the brain involved in pain experi- ence and behavior must include somatosensory projections as well as the limbic system. Furthermore, cognitive processes are known to involve widespread areas of the brain. Yet the plain fact is that we do not have an adequate theory of how the brain works. Melzack’s (1989) analysis of phantom limb phenomena, particularly the astonishing reports of a phantom body and severe phantom limb pain in people after a cordectomy—that is, complete removal of several spinal cord segments (Melzack & Loeser, 1978)—led to four conclusions that point to a new conceptual nervous system. THE GATE CONTROL THEORY 21 body part) feels so real, it is reasonable to conclude that the body we nor- mally feel is subserved by the same neural processes in the brain; these brain processes are normally activated and modulated by inputs from the body but they can act in the absence of any inputs. Second, all the qualities we normally feel from the body, including pain, are also felt in the absence of inputs from the body; from this we may conclude that the origins of the patterns that underlie the qualities of experience lie in neural networks in the brain; stimuli may trigger the patterns but do not produce them. Third, the body is perceived as a unity and is identified as the “self,” distinct from other people and the surrounding world. The experience of a unity of such diverse feelings, including the self as the point of orientation in the sur- rounding environment, is produced by central neural processes and cannot derive from the peripheral nervous system or spinal cord. Fourth, the brain processes that underlie the body-self are, to an important extent that can no longer be ignored, “built in” by genetic specification, although this built- in substrate must, of course, be modified by experience. These conclusions provide the basis of the new conceptual model (Melzack, 1989, 1990, 2001; Fig. Outline of the Theory The anatomical substrate of the body-self, Melzack proposed, is a large, widespread network of neurons that consists of loops between the thala- mus and cortex as well as between the cortex and limbic system.

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