how to create barcode in using c# NORMAL DEVELOPMENT OF THE NERVOUS SYSTEM in Microsoft Office


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A delay in motor development is often accompanied by mental retardation, in which case both are parts of a developmental lag or immaturity of the entire cerebrum The most severe forms of delayed motor development, associated with spasticity and athetosis, are usually manifestations of particular prenatal and paranatal diseases of the brain; these are discussed in Chap 38 In assessing developmental abnormalities of the motor system in the neonate and young infant, the following maneuvers, which elicit certain postures and re exive movements, are particularly useful: 1 The Moro response is the infant s reaction to startle and can be evoked by suddenly withdrawing support of the head and allowing the neck to extend A loud noise, slapping the bed, or jerking one leg will have the same effect causing an elevation and abduction of the arms followed by a clasping movement to the midline This response is present in all newborns and infants up to 4 or 5 months of age, and its absence indicates a profound disorder of the motor system An absent or inadequate Moro response on one side is found in infants with hemiplegia, brachial plexus palsy, or a fractured clavicle Persistence of the Moro response beyond 4 or 5 months of age is noted only in infants with severe neurologic defects The tonic neck re ex consisting of extension of the arm and leg on the side to which the head is passively turned and exion of the opposite limbs, if obligatory and sustained, is a sign at any age of pyramidal or extrapyramidal motor abnormality Barlow reports that he has obtained this re ex in 25 percent of mentally retarded infants at 9 to 10 months of age Fragments of the re ex, such as a brief extension of one arm, may be elicited in 60 percent of normal infants at 1 to 2 months of age and may be adopted spontaneously by the infant up to 6 months of age As with the Moro response, persistence beyond this age represents a malfunction of the nervous system The placing reaction in which the foot or hand, brought into contact with the edge of a table, is lifted automatically and placed on the at surface, is present in all normal newborns Its absence or asymmetry under 6 months of age indicates a motor abnormality In the Landau maneuver, the infant, if suspended horizontally in the prone position, will extend the neck and trunk and will break the trunk extension when the neck is passively exed This reaction is present by 6 months; its delayed appearance in a hypotonic child is indicative of a faulty motor apparatus If an infant is held prone in the horizontal position and is then dropped toward the bed, an extension of the arms is evoked, as if to break the fall This is known as the parachute response and is elicitable in most 9-month-old infants If it is asymmetrical, it indicates a unilateral motor abnormality The detection of gross delays or abnormalities of motor de-
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velopment in the neonatal or early infantile period of life is aided little by tests of tendon and plantar re exes Arm re exes are always rather dif cult to obtain in infants, and a normal neonate may have a few beats of ankle clonus The plantar response tends to be wavering and uncertain in pattern However, a consistent extension of the great toe and fanning of the toes on stroking the side of the foot is abnormal at any age The early detection of cerebral palsy is hampered by the fact that the corticospinal tract is not fully myelinated until 18 months of age, allowing only quasivoluntary movements up to this time For this reason, a congenital hemiparesis may not be evident until many months after birth Even then it is manifest only by subtle signs, such as holding the hand in a sted posture or clumsiness in reaching for objects and in transferring them from one hand to the other Later, the leg is seen to be less active as the infant crawls, steps, and places the foot Early hand dominance should always raise the suspicion of a motor defect on the opposite side In the upper limb, the characteristic catch and yielding resistance of spasticity is most evident in passive abduction of the arm, extension of the elbow, dorsi exion of the wrist, and supination of the forearm; in the leg, the change in tone is best detected by passive exion of the knee However, the time of appearance and degree of spasticity are variable from child to child The stretch re exes are hyperactive, and the plantar re ex may be extensor on the affected side With bilateral hemiplegia, the same abnormalities are detectable, but there is a greater likelihood of pseudobulbar manifestations, with delayed, poorly enunciated speech Later, intelligence is likely to be impaired (in 40 percent of hemiplegias and 70 percent of quadriplegias) In diparesis or diplegia, hypotonia gives way to spasticity and the same delay in motor development except that it predominates in the legs Aside from the hereditary spastic paraplegias, which may become evident in the second and third years, the common causes of weak spastic legs are prematurity and matrix hemorrhages These various forms of cerebral palsy are described in Chap 38 Developmental motor delay and other abnormalities are present in a large proportion of infants with hypotonia When the oppy infant is lifted and its limbs are passively manipulated, there is little muscle reactivity In the supine position, the weakness and laxity result in a frog-leg posture, along with an increased mobility at the ankles and hips Hypotonia, if generalized and accompanied by an absence of tendon re exes, is most often due to Werdnig-Hoffmann disease (an early-life loss of anterior horn cells-spinal muscular atrophy), although the range of possible diagnoses is large and includes diseases of muscle, nerve, and the central nervous system (see Chaps 38 and 52) The other causes of this type of neonatal and infantile hypotonia muscular dystrophies and congenital myopathies, maternal myasthenia gravis, polyneuropathies, Down syndrome, Prader-Willi syndrome, and spinal cord injuries are described in their appropriate chapters Hypotonia that arises in utero may be accompanied by congenital xed contractures of the joints, termed arthrogryposis, as discussed in Chap 52 Infants who will later manifest a central motor defect can sometimes be recognized by the briskness of their tendon re exes and by the postures they assume when lifted In the normal infant, the legs are exed, slightly rotated externally, and associated with vigorous kicking movements The hypotonic infant with a defect of the motor projection pathways may extend the legs or rotate them internally, with dorsi exion of the feet and toes Exception-
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