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Anticonvul- alter the individual’s functioning ability or sant medications may be prescribed if well-being buy generic brahmi 60caps line. Contractures can limit both individuals also have a seizure disorder passive and active joint movement and associated with cerebral palsy buy 60 caps brahmi otc. Orthopedic can interfere with self-care purchase brahmi 60 caps mastercard, walking 60caps brahmi for sale, and surgery may be needed to correct joint sitting discount brahmi 60caps with visa. Some individuals with cerebral pal- deformities or to lengthen muscles or ten- sy also experience bowel and bladder in- dons in order to decrease muscle spasm. Be- and bladder incontinence can be managed cause of insufficient muscle activity, some through training programs that help indi- individuals may be more prone to osteo- viduals establish dietary control and a reg- porosis, which in turn can cause pain and ular evacuation schedule, as well as increase susceptibility to fractures. Poorly programs to increase awareness of the sen- aligned joints may predispose them to sory stimuli that indicate a need for evac- degenerative joint disease, resulting in uation. In some dental problems through training in oral instances, if individuals have poorly sup- hygiene and regular dental care. A specif- ported sitting posture, scoliosis (lateral ic program of weight bearing and muscle curvature of the spine) may occur, com- activity as well as a diet adequate in cal- promising breathing as well as the func- cium can help to prevent osteoporosis. If coughing and Training that helps individuals increase swallowing ability is insufficient, aspira- posture control and the use of braces and tion of food or fluids may place individ- splints can retard the development of uals at risk of respiratory infections or degenerative joint disease and scoliosis. Training to help individuals develop Although not necessarily a complica- improved breathing patterns, coughing, tion, fatigue secondary to manifestations and lung expansion can decrease the of cerebral palsy can also interfere with chances of aspiration and consequently individuals’ ability to function efficiently. Because they may experience difficulty with Adequate rest at night as well as estab- motor control and coordination, more lishment of rest periods throughout the energy may be expended to carry out even day can decrease fatigue. Involuntary viduals’ total energy output and adjusting movement or spasticity may also increase their tasks and schedules to fit their needs the amount of energy expended. As a can help preserve energy and prevent result, individuals with cerebral palsy excessive fatigue. Complications of Cerebral Palsy Psychosocial Issues in Cerebral Palsy Because of the manifestations of cere- Although data regarding the psychoso- bral palsy, a variety of complications that cial adjustment of adults with cerebral pal- are secondary to the condition itself can sy are limited, cerebral palsy as a develop- Conditions Affecting the Brain 59 mental disability poses many of the same For adolescents with cerebral palsy, problems as other developmental disabil- opportunities to participate in social activ- ities. Misunderstanding of the condition ities, information related to sexuality, and by parents, teachers, or others with whom opportunities to participate in sexual individuals with cerebral palsy come in exploration and relationships may have contact can perpetuate a sick and depend- been limited. In addition, adolescents ency status rather than one of empower- with cerebral palsy may have a distorted ment. How individuals with cerebral palsy body image and a low self-concept, which were treated in childhood can influence can affect their social competence, dating, their self-perception and functioning in and sexual behavior. With any type of developmen- als with cerebral palsy, as adolescents as tal disability there is the risk of overpro- well as adults, experience normal desires, tectiveness by parents and others, which they may lack the skills necessary to ful- can impede the individual’s emotional fill those needs. In addition to barriers of development by restricting access to expe- inadequate information, skill, or opportu- riences that are vital to the development nity for appropriate sexual expression, of adequate coping strategies. As a result, they may also experience physical barri- children may learn, at an early age, to use ers because of their disability that make maladaptive behavior to achieve goals. Individu- overly dependent on parents, have been als with communication problems as the given little responsibility for home chores, result of cerebral palsy may have grown up have not been confronted with the typi- in an environment in which family, cal consequences of behavior, or have not friends, and others became accustomed to learned acceptable means of expressing their adaptive communication methods. For often been the focus of a wide variety of instance, those unfamiliar with the indi- services and activities from an early age vidual or with cerebral palsy itself may may continue these expectations into misinterpret problems with hearing or adulthood, demonstrating a sense of ego- unintelligible speech as lack of cognitive centricity that may limit positive social ability. In other instances, because the interactions and lead to further social iso- individual may be difficult to understand, lation. If these behaviors persist into adult- acquaintances may begin to avoid inter- hood, they may become more of an actions with the individual who then impediment to social integration than the becomes socially isolated. At the severity and type of cerebral palsy, times brain damage associated with cere- decreased mobility, problems with eating, bral palsy may also create behavior deficits or problems with personal hygiene may that can interfere with the development further restrict the individual’s social and maintenance of social relationships. Consequently, follow-up through- out the individual’s life may be necessary. Epilepsy As individuals age with their disability, additional limitations may develop. For Epilepsy is a chronic disorder of the instance, fatigue is a consideration for nervous system. It is not a disease, but individuals with cerebral palsy, regardless rather a symptom of an underlying neuro- of age. However, as individuals become logical condition in which neurons in the older, endurance for the same activities brain create abnormal electrical discharges once performed may be decreased.

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During the Crusades soldiers cooked the bones of their dead comrades so that they could be returned home for proper burial brahmi 60 caps visa. Even this act cheap 60 caps brahmi with mastercard, however trusted brahmi 60caps, was eventually considered sacrile- gious and strongly condemned by the Church purchase brahmi 60 caps on-line. One of the ironies of the Middle Ages was that the peasants received far less respect and FIGURE 1 cheap 60 caps brahmi with visa. They are representative of the medical equipment used throughout the Roman Empire during this time. Contributions of Islam The Arabic-speaking people made a profound contribution to compiled nearly 500 medical papers (of which 83 have been pre- the history of anatomy in a most unusual way. It was the Islamic served) from earlier works of others, as well as from his personal world that saved much of Western scholarship from the ruins of studies. He perpetuated the concept of the humors of the body the Roman Empire, the oppression of the Christian Church, and and gave authoritative explanations for nearly all body functions. With the expansion of Islam Galen’s works contain many errors, primarily because of through the Middle East and North Africa during the eighth his desire to draw definitive conclusions regarding human body century, the surviving manuscripts from Alexandria were taken functions on the basis of data obtained largely from animals back to the Arab countries, where they were translated from such as monkeys, pigs, and dogs. He proved to be an experimentalist, demon- Church attempted to stifle any scholarship or worldly knowledge strating that the heart of a pig would continue to beat when that was not acceptable within Christian dogma. The study of spinal nerves were transected so that nerve impulses could not the human body was considered heretical, and the Church reach the heart. He showed that the squealing of a pig stopped banned all writings on anatomical subjects. Without the Islamic when the recurrent laryngeal nerves that innervated its vocal repository of the writings of Aristotle, Hippocrates, Galen, and cords were cut. Galen also tied off the ureter in a sheep to prove others, the progress of centuries in anatomy and medicine would that urine was produced in the kidney, not in the urinary blad- have been lost. It wasn’t until the thirteenth century that the der as had been falsely assumed. In addition, he proved that the Arabic translations were returned to Europe and, in turn, trans- arteries contained blood rather than pneuma. During the translation process, any Arabic termi- Galen compiled a list of many medicinal plants and used nology that had been introduced was systematically removed, so medications extensively to treat illnesses. Although he fre- that today we find few anatomical terms of Arabic origin. He accumulated a wide variety of medical instruments and suggested their use as forceps, retractors, scissors, and splints (fig. He was also a strong advocate of helping nature heal through good epidemic: Gk. History of Anatomy © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 1 History of Anatomy 13 Renaissance The period known as the Renaissance was characterized by a re- birth of science. It lasted roughly from the fourteenth through the sixteenth centuries and was a transitional period from the Middle Ages to the modern age of science. The Renaissance was ushered in by the great European universities established in Bologna, Salerno, Padua, Montpel- lier, and Paris. The first recorded human dissections at these newly established centers of learning were the workof the sur- geon William of Saliceto (1215–80) from the University of Bologna. The study of anatomy quickly spread to other universi- ties, and by the year 1300 human dissections had become an in- tegral part of the medical curriculum. However, the Galenic dogma that normal human anatomy was sufficiently understood persisted, so interest at this time centered on methods and tech- niques of dissection rather than on furthering knowledge of the human body. The development of movable type in about 1450 revolu- tionized the production of books. Celsus, whose De re medicina was “rediscovered” during the Renaissance, was the first medical author to be published in this manner. Among the first anatomy books to be printed in movable type was that of Jacopo Beren- gario of Carpi, a professor of surgery at Bologna. He described many anatomical structures, including the appendix, thymus, FIGURE 1. The most influential text of the period was written ciculus Medicinae by Johannes de Ketham. The anatomy professor by Mondino de’ Luzzi, also of the University of Bologna, in 1316. The dissections were performed by hired First published in 1487, it was more a dissection guide than a assistants. One of them, the ostensor, pointed to the internal struc- study of gross anatomy, and in spite of its numerous Galenic er- tures with a wand as the professor lectured.

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POSTDEPOSITION You will be offered the opportunity to read your deposition and to correct any errors in how the transcriber heard you order 60 caps brahmi with visa. If you want to 60 Epstein make substantial changes purchase 60 caps brahmi fast delivery, then ask your attorney cheap 60caps brahmi with amex. In general buy brahmi 60caps otc, any changes made to the deposition that are substantial will look damag- ing buy cheap brahmi 60caps online. Some jurisdictions will allow such substantial changes to the deposition and others will not. If there are any discrepancies in what you said in the deposition, as opposed to what you will say at trial, then prepare how to explain them. You should have a postdeposition meeting to assess the case and your ability to defend it successfully. You should also ask your attorney about reading other depositions in the case. For example, reading the plaintiff’s deposition will show how he or she sees the case and what arguments may be used during the case. The potential advantage of sitting in on some depositions is that the plaintiff’s expert and plaintiff may be more truthful in the presence of the defending physician. The dis- advantage is that depositions take time away from your practice, and it is hard to listen to an expert impugning you. If you do sit in on a deposition and something is said on which you want to comment to your lawyer, make a note of it and discuss it with him or her in private. Before your trial, read your deposition carefully, and virtually memo- rize it so that you will be consistent at trial. Before your court date, visit the courtroom to familiarize yourself with the setting. Plan on attending the entire trial, demonstrating that you care about the case. It is also reasonable to have your spouse attend the trial once or twice to show your human side. When sitting in the court- room and during other testimony, make eye contact with the jury. Identify inaccuracies made by other witnesses or points that can be used by your attorney, which can be discussed with your attorney when there is a break in the case. The following are some guidelines on handling yourself at trial (see the Discovery: Deposition section for how to answer questions posed by the plaintiff attorney)(1–3,8–10). Men are encouraged to wear dark suits, and subtle ties, but not bow ties, which have an eccentric connotation. Turn to face the lawyer when he or she poses a question and then turn to the jury to answer the question. Do not use medical terminology that the jury will not understand, but also try not to talk down to the jury. The use of models, diagrams, and photographs can help illustrate points clearly. The plaintiff attorney will try to chal- lenge your reputation and make you nervous. Jurors expect attorneys to be arrogant and aggressive, in part based on portrayals of attor- neys by the media. I have been involved in several cases in which the same attorney who grilled me on one case asked if he could hire me on a different case because I did such a good job under fire at a deposition. If you recog- nize that these attorneys are only doing what is expected of them, it may help in removing some of the emotion from the situation. Outside the courtroom, either before, during, or after breaks, always retain your professional demeanor. Jurors could see you and think that you are not taking the case seri- ously. Also, do not talk about the case until your lawyers says it is okay, because the other side can pick up remarks. ACKNOWLEDGMENT This is an excerpt from an article entitled “Pathologists and the Judi- cial Process: How to Avoid It” by Jonathan I.

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