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Cross References Dysphonia; Tremor Von Graefes Sign Von Graefes sign medications januvia buy genuine antabuse, or Graefes sign treatment gonorrhea purchase antabuse with visa, is the retarded descent of the upper eyelid during movement of the eye from the primary position to downgaze; the lid fol- lows the eye medicine 013 antabuse 500mg for sale. This may be termed lid lag medications gerd cheap antabuse, although some authorities reserve this term for a static situation in which the lid is higher than the globe on downgaze medications knowledge purchase genuine antabuse online. Cross References Myotonia; Paramyotonia Wartenbergs Sign (1) In ulnar neuropathy medicine ubrania antabuse 250 mg lowest price, Wartenbergs sign refers to the slightly greater abduction of the fth digit on the affected side, due to paralysis of the adducting pal- mar interosseous muscle and unopposed action of the radial-innervated extensor muscles (digiti minimi, digitorum communis. With the patient standing, the examiner holds the shoulders and gently shakes backwards and forwards, the two sides out of phase. Normally, the passive arm swing induced by this move- ment will be out of phase with the trunk movements, but in rigidity the limbs and trunk tend to move en bloc. Passive swinging of the wrist or elbow joint may also be performed to assess rigidity. Cross References Parkinsonism; Rigidity; Rolex sign; Spasticity Wasting Wasting refers to a thinning of the musculature, also known as atrophy or, if of neurogenic origin, amyotrophy. Wasting may also be seen in general medical disorders associated with a profound catabolic state. However, this is not a linear scale; grade 4 often becomes subdivided into 4,4,and4+(oreven5) according to the increasing degree of resistance which the examiner must apply to overcome activity. It is also important to assess what effort the patient is making to comply with the testing; apparent weakness or pseudoparesis may be shorthand for lack of patient effort. Testing records only - 370 - Wernickes Aphasia W the best-forced maximal contraction and should not develop into an unseemly trial of strength between patient and examiner. Accepting all these difcul- ties, it should be acknowledged that the grading of weakness, like all clinical observations, is subject to some degree of observer bias. However, there is no evidence that pure lesions of the pyramidal tracts produce this picture: pyramidotomy in the monkey results in a decit in ne nger movements, but without weakness. Coexistent wasting suggests that muscle weakness is of lower motor neurone origin, especially if acute, although wasting may occur in long-standing upper motor neurone lesions. Weakness with minimal or no mus- cle wasting may be non-organic, but may be seen in conditions such as multifocal motor neuropathy with conduction block. Cross Reference Rinnes test Wernickes Aphasia Wernickes aphasia is the classical receptive aphasia, in distinction to the expressive aphasia of Broca, although this classication is problematic since there are concurrent expressive problems in Wernickes aphasia. Other terms sometimes used for Wernicke-type aphasia are sensory aphasia or posterior aphasia. There may be associated anxiety, with or without agitation and paranoia, and concurrent auditory agnosia. Because of a loss of self-monitoring of out- put, patients are often not aware of the impairment, and behavioural disturbance sometimes misdiagnosed as acute confusional state and even referral or admis- sion to psychiatric hospital may occur, particularly if there is no or minimal accompanying hemiparesis. The differential diagnosis of Wernickes aphasia includes delirium and schizophasia. Wernicke placed it in the posterior two-thirds of the superior temporal gyrus and planum temporale (Brodmann area 22), but more recent neuroradio- logical studies (structural and functional imaging) suggest that this area may be more associated with the generation of paraphasia, whereas more ventral areas of temporal lobe and angular gyrus (Brodmann areas 37, 39, and 40) may be asso- ciated with disturbance of comprehension. A correlation exists between the size of the lesion and the extent of the aphasia. A similar clinical picture may occur with infarcts of the head of the left caudate nucleus and left thalamic nuclei. Cross References Agnosia; Agraphia; Alexia; Anomia; Aphasia; Brocas aphasia; Jargon apha- sia; Logorrhoea; Paraphasia; Pure word deafness; Schizophasia; Transcortical aphasias Wheelchair Sign the so-called wheelchair sign describes patients with parkinsonism who start to use a wheelchair for mobility early in the course of their disease, usually because of repeated falls. Cross References Parkinsonism; Rocket sign - 372 - Woltmans Sign W Wing-Beating Tremor Wing-beating tremor is absent at rest but develops when the arms are extended, hence this is a postural tremor. Cross Reference Tremor Winging of the Scapula Winging of the scapula, or scapula alata, is a failure to hold the medial border of the scapula against the rib cage when pushing forward with the hands. It is most easily observed by asking the patient to push or press against a wall or the examiners hand whilst observing the scapula which lifts away from the posterior chest wall. Winging of the scapula may be a consequence of weakness of the serratus anterior muscle, usually due to a neuropathy of the long thoracic nerve of Bell, but sometimes as a consequence of brachial plexus injury or cervical root (C7) injury. Weakness of trapezius, particularly the middle trapezius muscle, may also cause winging of the upper part of the scapula, more prominent on abduction of the arm, when the superior angle of the scapula moves farther from the midline. Witzelsucht Witzelsucht, or the joking malady, refers to excessive and inappropriate face- tiousness or jocularity, a term coined in the 1890s for one of the personality changes observed following frontal (especially orbitofrontal) lobe injury. Cross References Emotionalism, Emotional lability; Frontal lobe syndromes; Moria Woltmans Sign Woltmans sign denotes slow-relaxing, or hung-up, tendon reexes. These are most commonly seen in the context of untreated hypothyroidism, but have also been recorded in other situations, including treatment with -blockers, diabetes mellitus, and complete heart block. The phenomenon is sometimes labelled pseudomyotonia because of its supercial resemblance to the slow muscle relax- ation of myotonia, but electrophysiological testing does not show myotonic discharges. Chorea may result in apparently hung-up reexes, perhaps due to a choreiform jerk after muscle relaxation. The mechanisms underlying Woltmans sign are uncertain: changes in basal metabolic rate and in muscle bre types (selective loss of fast twitch bres) have been suggested. Normalisation of slow-relaxing tendon reexes (Woltmans sign) after cardiac pacing for complete heart block. Cross References Chorea; Myotonia; Pseudomyotonia Wrestlers Sign this name has been given to the excessive effort in irrelevant muscle groups accompanied by prominent non-verbal signs of effort such as grunting in patients with apparent (functional) weakness. It may coexist with intermittent voluntary effort, collapsing weakness, cocontraction of agonist and antagonist muscles, and inconsistency in clinical examination (e. Cross Reference Collapsing weakness Wrist Drop Wrist drop describes a hand hanging in exion due to weakness of wrist extension. This results from radial nerve palsy, either in the axilla or spiral groove of the humerus (Saturday night palsy, although other nerves may also be compressed by hanging the arm over a chair. Distal lesions affecting branches of the posterior interosseous branch of the radial nerve may produce more circumscribed deformity, such as weak extension of metacarpophalangeal joints (nger drop, thumb drop. Writers Cramp Writers cramp, also known as graphospasm, la crampe des ecrivains,or scriveners palsy, is a focal dystonia involving the hand and/or arm muscles, caus- ing abnormal posturing of the hand when writing; it is the most common of the task-specic dystonias (once known as craft palsies. When attempting to write, patients may nd they are involuntarily gripping the pen harder, and there may also be involuntary movement at the wrist or in the arm. A tremor may also develop, not to be confused with primary writing tremor in which there is no dystonia. Attempts to use the contralateral hand may be made, but this too may become affected with time (mirror dystonia. The problem may be exclusive to writing (simple writers cramp) but some peo- ple develop difculties with other activities as well (e. There is some neurophysiological evidence that the condition is due to abnor- malities within the spinal cord segmental motor programmes and muscle spindle afferent input to them. Writers cramp may be amenable to local botulinum toxin injections into the hand or arm muscles responsible for the involuntary movement. Excessive or pathological yawning (chasm) is compulsive, repetitive yawning not triggered by physiological stimuli such as fatigue or boredom. Cross References Parkinsonism; Sighing Yips Yips is the name given to a task-specic focal dystonia seen in golfers, especially associated with putting. Abnormal co- contraction in yips-affected but not unaffected golfers: evidence for focal dystonia. Yo-yo-ing is difcult to treat: approaches include dose fractionation, improved drug absorption, or use of dopaminergic agonists with concurrent reduction in levodopa dosage. Cross References Akinesia; Dyskinesia; Hypokinesia - 380 - Z Zeitraffer Phenomenon the zeitraffer phenomenon has sometimes been described as part of the aura of migraine, in which the speed of moving objects appears to increase, even the vehicle in which the patient is driving. Zooagnosia the term zooagnosia has been used to describe a difculty in recognizing ani- mal faces. In one case, this decit seemed to persist despite improvement in human face recognition, suggesting the possibility of separate systems for animal and human face recog- nition; however, the evidence is not compelling. In a patient with developmental prosopagnosia seen by the author, there was no subjective awareness that animals such as dogs might have faces. Nonrecogntion of familiar animals by a farmer: zooagnosia or prosopagnosia for animals. Cross References Agnosia; Prosopagnosia Zoom Effect the zoom effect is a metamorphopsia occurring as a migraine aura in which images increase and decrease in size sequentially. Approved by, Signature : Supervisor : Mr Chong Yu Zheng Date : 8 May 2017 Signature : - Co-Supervisor : - Date : - iv the copyright of this report belongs to the author under the terms of the copyright Act 1987 as qualified by Intellectual Property Policy of Universiti Tunku Abdul Rahman. Due acknowledgement shall always be made of the use of any material contained in, or derived from, this report. Apart from his valuable advice, I am very grateful Mr Chong patience in teaching me all the time and arranged a testing session for me to test my prototype in rehabilitation centre located at Hulu Langat, that testing session was a great experience for me because that is the only way I can understand cerebral palsy children difficulty in movement and problem. Apart from that, I would like to thank my parents for helped in welding the prototype, suggestion and etc. Last but not least, I would like to thank workshop and lab technician for their patient in teaching and helping me along the way. Most of the hand cycle equipment or rehabilitation devices available in the market are purposely design for adults, none of them is suitable for children in term of design load and physical size. After gone through some literature review, the reason why most rehabilitation devices existed is not suitable for children because the device in the market is not equipped with a sensory system to tracking the parameter and also a lack of suitable training algorithm. Moreover, the physical size and load of the rehabilitation device in the market consider too big or heavy for children. Hence, this final year project mainly aims to develop a handcycle device for cerebral palsy children which include the sensory system and training algorithm. Basically, the objectives of this project are to develop a rehabilitation device for cerebral palsy children which able to display some parameter like heartbeat or body temperature and provide a suitable training algorithm. The control system in this project consists of an automated motor system incorporated with a customised user training algorithm. The first part is the mechanical part which refers to the wheelchair bone structure and the dimension, the mechanical part is considered as the most important feature among all because if any negligence in the design or mistake in the design, it might injuries the children. Moreover, the second part which refers to the electronic and sensory part such as the controller, display, sensor and etc. The second part needs to design properly such as protection and voltage current rating value otherwise the electronic components might get burnt easily in an abnormal condition. The third part must properly incorporate with second part otherwise we will not able to get the correct data in parameter monitoring and the system will not run in an optimum condition which considers as wasting power. This rehabilitation device will include a sensory system for parameter displaying. Meanwhile, it will automatic upload the patience results into the google drive server for safety record. Moreover, this device will have training algorithm to train the child by providing a motion on both wheels. This project is purposely designed for cerebral palsy children which are the important aspect of this project because that have lots of retailer or manufacturer sell rehabilitation device but most of their device in the market are for adult usage. Thus, most of the devices existed in the market are not suitable for children in term of physical size and tension. So, this project will be programmed with a counter or timer to replace a real specialist to 2 keep count the time. If the time for certain posture training has been up, then this device will give the notice to indicate rest time or change training pattern. Hence, there are several aims and objectives to be achieved throughout this project: 1) Develop a rehabilitation device for cerebral palsy children. In united states that have approximate 1 out of 1000 new birth are affected by cerebral palsy or limb movement disorder. Meanwhile, in the United Kingdom that has approximate 1 out of 400 new births are affected by this disease and there are an estimated that have approximate thirty thousand of cerebral palsy children in the United Kingdom nowadays (Wiley Online library, 2017. In addition, the Cerebral palsy disease affects a persons limb ability in movement and self- balance. Cerebral palsy generally caused by brain damage or improper development of the brain in early childhood time which in turns affect their ability in controlling limb movement and maintain correct posture. Physical therapy is the most common therapy that will be introduced when diagnosing the cerebral palsy patient. Physical therapy for cerebral palsy patient normally make use of rehabilitation devices to improve their ability in movement but most of the rehabilitation devices in the market nowadays are incompatible for children in term of tension and physical size. Moreover, those devices available in the market are purposely designed for adult and it lacks training algorithm. In addition, the available device might require a specialist to control and keep supervise. Hence, it is the reason for us to do this project in order to solve the above problem. From the cerebral palsy word itself, we know that it is a movement disorder that relates to our brain. Moreover, in 1840 William Little has described that Cerebral palsy disease is a collective developmental disability. Cerebral palsy is a disease which covering numbers of motor function impairment to the injuries of the brain cell which arising in childhood (Sankar & Mundkur 2005.

Therefore treatment vitiligo purchase antabuse 500mg otc, when you see lists of risk factors for heart attack or stroke world medicine buy antabuse line, think of what it takes to prevent the disease from developing further or reverse the disease process medicine 853 order antabuse 250mg line. The risk factors of hypertension treatment question order antabuse 250 mg without a prescription, heart disease treatment skin cancer purchase antabuse overnight delivery, diabetes symptoms mercury poisoning cheap antabuse american express, cigarette smoking, high cholesterol, stress, and many others can all be eliminated. Even your genetic predisposition for disease expression gets reduced dramatically by a healthy lifestyle. In other words, will interest her or his reversing or slowing endothelial dysfunction must patients in the care of the be the cornerstone of therapy. One study that is quite impressive reported the following: human frame, in a proper I the intervention group ate: Plant foods such as diet, and in the cause and fruits, vegetables, legumes, and grains without prevention of disease. Edison Alternative and Natural Interventions for Cardiovascular Disease G 33 yogurt. Stress-reduction and needed behavioral modification was also given during this year study period. I the control group followed the usual dietary recommendations for heart disease patients: Cutting out butter; largely eating chicken or fish instead of beef, reducing fat intake from 40 to 30 percent of the diet, reducing cholesterol to less than 200 mg per day, exercising and no more smoking. I Researchers found reversal of coronary artery atherosclerosis in 82 percent of patients after one year as verified by initial and follow-up angiography. This statistic included old and young alike, no matter how advanced their atherosclerosis! I In contrast to the intervention group, the majority of the control group patients had a worsening of atherosclerosis at one year. The extent of dietary change in these study subjects far exceeded what typical recommendations are given to patients after a cardiac event at hospitals today. Further in this report you will see how dietary interventions play a huge role in preventing and treating cardiovascular disease and its causes. According to a 1980 article in the Lancet, diet and obesity were shown to correlate with the rise in arterial pressure among urbanized 75 and tribal South Africans. When liquid cleansing for one to two weeks is then followed by reintroducing nutrient-rich, whole foods, the effect is quite dramatic. She suffered with fluid retention, headaches, rash, achy joints, low energy, and low self esteem. She returned to excitedly tell me and the office staff that she had lost 30 pounds, regained her energy and her self confidence. Her headaches almost vanished, her joint pains were gone, and her rash was resolving. The Lemonade Cleanse for Three to Ten Days the lemonade diet consists of fresh squeezed lime or lemon juice, grade B maple syrup, and cayenne pepper mixed with water. An herbal laxative tea is taken twice a day, and no solid food is eaten during the entire three to ten days. It may also be safely extended for 40 days, depending upon your physical condition. Expect to experience the symptoms of sweating, increased urination, diarrhea or decreased bowel movement, mild weakness, and even a change in breath odor. On the second and succeeding bottles, experiment with more or less citrus juice, more or less maple syrup and more or less cayenne. For lunch or dinner consider hot water (like a soup broth) with increased cayenne to get a powerful spice taste. Add natural sweetener and a dash of soymilk, rice milk, or almond milk, but keep warm to hot. Herbal Laxative Drink: Morning and evening herbal laxative teas are filling, relaxing, and stimulate bowel cleansing. The more your bowels move, the more lemonade drink and powdered whey you will want to consume. Those with systolic blood pressures greater than 180 mmHg and diastolic blood pressures greater than 110 mmHg experienced reductions of 60 mmHg systolic and 17 mmHg diastolic on average after the seven days of eating the vegan diet. All subjects discontinued their antihypertensive medications with no adverse events reported by the researchers. But just know that you may not alter the cholesterol value on a blood test, in fact it is lowered only by about two to four percent based on a review of 16 trials measuring the effect 77 diet can have on lowering cholesterol. This is because the body will increase the production of cholesterol when you eat less cholesterol and decreases when you eat more. But once again, you will have a profound effect on lowering your risk of cardiovascular disease. The 1996 British Medical Journal reported a study of 10,771 healthy subjects who were recruited from health food shops and vegetarian societies and were followed for approximately 17 years. They were monitored as to their vegetarian eating and consumption of whole grain bread, bran cereal, nuts, dried or fresh fruit, and raw salad. They noted that their daily consumption of fresh fruit was associated Alternative and Natural Interventions for Cardiovascular Disease G 35 with significantly reducing the death rate from coronary artery disease and stroke. This is one of many studies showing dramatic results from simply eating nutrient-rich, whole foods on a consistent basis, without using many other natural therapies, stress reducers, exercise, etc. The reason why the cholesterol number will not change much is due to the following more detailed reasons: When we eat saturated fat it enters our blood stream through a complex, fat-circulation system called the lymphatic system. When chylomicrons get spilled into the blood from the lymph, cholesterol is essential to stabilize the fat they contain. This explains why the low cholesterol, low animal fat diet cannot lower cholesterol more than, on average, a few percent. So keep in mind that cholesterol really is not bad, and that it is not what we are treating, ultimately. It is the other factors of cardiovascular disease that I get concerned with, of which cholesterol is possibly only one indicator. Some Interesting Studies on the Food-Cholesterol Disconnection In the early 1950s the Framingham Study failed to find a connection between eating habits and blood cholesterol levels in more than 1,000 people. There is a considerable range of serum cholesterol levels within the Framingham Study Group. The diets of 100 school children were evaluated showing no connection between the two. Those who ate large amounts of animal fat had just as much cholesterol in their blood as those who ate very little animal fat. A similar study of 185 children was performed in New Orleans 80 with similar results. In an Israeli study in Jerusalem, the intake of animal fat of the 10,000 subjects varied from 10 grams up to 200 grams daily, and they also had a wide variation in their cholesterol values. But there was no relation, as extremely low cholesterol values were seen in those who ate little and in those 81 who ate the most animal fat. Despite the fact that diet may not affect cholesterol levels in most people, diet has a huge impact on heart health and the health of the rest of your body. For example, excess simple sugar may not affect cholesterol, but it clearly promotes obesity and proinflammatory markers like C-reactive protein over time; worsens insulin resistance (contributing to metabolic syndrome X and diabetes); increases triglycerides, and more. So indirectly, sugar really does worsen your heart attack rate, but there is no money in getting Americans to stop eating refined sugar. Lowering your cholesterol as you lower other underlying risks for cardiovascular disease is still a good idea. Fiber is particularly well suited to help heart health because of its ability to bond with cholesterol and take it out of the body. Oat bran, pectin, broccoli, legumes, ground seed, whole grains, and rice all constitute healthy sources of natural fiber that, if taken daily, may not only make you regular, but provide a terrific source of cholesterol reduction. I recommend you eat six servings of vegetables and three servings of fruit daily, plus beans and grains. In order to consume 75 grams of fiber daily, one must eat nine servings of fruit and vegetables, a lesser amount of cereal containing fiber, and lesser still of bread, even if it is from whole grain. Exercise Every person is drawn towards one activity they like to do for their body. It is critical to find something you truly enjoy if you are going to be able to continue your routine over the long term. With exercise, the temperature inside your muscles increases the rate of metabolism 17 percent or more. It flushes toxic wastes from your body; thats why regular exercise reduces the risk of cancer, heart disease, and more. Even the Nurses Health Study (more than 23,000 nurses participating) found that in the more than 2,200 women in whom cardiovascular risk was being tracked, those who exercised approximately ten minutes, six days per week, had the same risk reduction compared to those who took Lipitor 10mg daily! And yet the women who exercised had other health benefits that the Lipitor patients missed out on. Reduce Sugar Consumption Consider carbohydrates in the form of vegetables, whole fruits, fresh fruit juice and whole-grained foods. The table on Natural Sweeteners for Your Health (page 38) will guide you with sugar consumption. Eliminate Hydrogenated and Trans Fats from Your Meals and Snacks this process of hydrogenation basically kills omega-3 oils. This process was introduced into North America by Procter & Gambles first Crisco cookbook in 1912. Please limit refined fructose consumption because it has been shown to damage cellular function through a process called glycation of many age-related chronic diseases. Because it decreases infection from tooth-harming bacteria in the mouth, xylitol gums have actually been well proven to reduce dental cavities. However, the fruit itself is always a healthier sugar than the powder from the fruit. The Healthiest Form of Sugar is from Whole Foods Better than all those sugars listed above are fruits and vegetables. These whole-food sugars also come with micronutrients known as fiber, enzymes, complete vitamins, organic minerals, antioxidants, and phytochemicals. Both scientific literature and clinical experience definitively show that diets high in fiber, fruits, vegetables, and herbal teas significantly reduce the occurrence of a host of deadly diseases listed above! You get them from red meat, processed meats, high-fat dairy products, and commercially deep-fat fried foods. So avoid these: I Organ meat including liver, kidney, brains, heart, stomach, etc. I Skin of poultry I Fried foods, including deep-fat fried fish I Fatty red meat I Processed meat of any type, including those made from turkey or chicken (surprisingly, these are often higher in fat than those made from beef) I High fat dairy products, including milk, butter, cheese, ice cream, and yogurt Healthier fats come in the form of whole foods such as avocados. Others safer fats are: I Cultured dairy products, sour cream, plain yogurt, cottage cheese, fetta cheese, blue cheese, and other fermented cheeses. Omega-3 fatty acids have recently been shown to be more effective than statin drugs according to 83 a published meta-analysis Swiss researchers reviewed 97 random controlled clinical trials, including more than 275,000 participants, and discovered that statin drugs decreased mortality by 22 percent, but omega-3 fatty acids decreased mortality by 32 percent. Even death from any cause was reduced by only 13 percent with statins but by 23 percent with omega-3 fatty acids! Why not make fish (like ocean-raised salmon, herring and mackerel), cod liver oil, olive oil, borage oil, primrose oil, and flaxseed oil a part of every meal Keeping Blood Thin Naturally Nattokinase is a potent fibrin inhibitor, reducing blood thickness and atherosclerosis of heart disease and stroke. I have a patient that does better on nattokinase and vitamin E than he did on Coumadin and Lovenox shots for recurrent pulmonary embolisms (clots to the lungs. Alternative and Natural Interventions for Cardiovascular Disease G 39 Serrepeptase digests blood clots and possibly arterial plaque. Serrapeptase, however, has no inhibitory effects on prostaglandins so stomach acid level remains unchanged. Perfusion of blood where it was formerly insufficient is the recognized method of reversing angina pectoris and lower extremity claudication. It is also the way to keep vessels working, blood pressure down, and slow or stop the progression towards atherosclerosis. Fortunately, there are a few who know how to expose misleading study design or those studies in which researchers report negative interpretations of what are actually positive results. In fact, you will find that most of the peer-reviewed literature available on the National Library of Medicines public access website (

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Syndromes

• Yellow skin color (jaundice)
• Symptoms of Becker muscular dystrophy appear
• Hives
• Bilirubin level and blood tests for liver function
• Understands the meaning of "no"
• Bleeding
• Urine copper