This document discusses motor control and spasticity. It begins by noting that stroke is one adverse event that can impact motor control. Symptoms of reduced motor control after stroke include weakness and fatigueability, while increased motor control results in spasticity, increased reflexes and altered tone. The document then discusses measuring spasticity, citing the Lance definition which describes it as a velocity-dependent increase in muscle tone and tendon reflexes due to hyper-excitability of the stretch reflex. Finally, it explores the relationship between muscle activity and stiffness, questioning whether stiffness changes if muscle activity is eliminated.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Anand Pandyan - The lumping and splitting of spasticity
1. 24/09/2012
Conceptual Model of
motor control
Sensei
Motor control / capacity …
The lumping and splitting of
spasticity
Mark
Prof Anand D Pandyan
Independence
a.d.pandyan@keele.ac.uk
Me
threshold
0 Twilight zone
Life span (years)
An illustration of motor control Control significantly improves with
practice over time
Stroke is one of many adverse The paradoxical symptoms resulting
events in life… from loss of activation
Motor control / capacity …
Stroke Increased activity Reduced activity
•Increased reflexes •Weakness
•Spasticity •Fatigueability
•Altered tone •Loss of fine
•Spasm & Clonus motor control
Independence
threshold
•Abnormal
movement patterns &
0 Twilight zone co-contraction
Life span (years)
1
2. 24/09/2012
Why should one consider spasticity The starting point for measuring
as important?
spasticity
Motor control / capacity …
Stroke
The Lance definition….
A motor disorder characterised by a velocity
dependent increase in the tonic stretch reflex
(muscle tone) with exaggerated tendon
reflexes, resulting from the hyper-excitability of
Independence
threshold
the stretch reflex …
0 Twilight zone
Life span (years)
What is muscle tone? Measuring spasticity
1. Resistance one feels when The Lance definition….
stretching the joint A motor disorder characterised by a velocity
Need a measure of stiffness dependent increase in the tonic stretch reflex
(muscle tone) with exaggerated tendon
reflexes, resulting from the hyper-excitability of
the stretch reflex...
2. The state of readiness of the muscle
to act Need a measure of muscle
activity
Measuring stiffness & muscle activity
Displacement
Force to move limb
EMG
M uscle activity extensors Force/M oment
Muscle activity flexors
EMG
Joint Angle
2
3. 24/09/2012
Does stiffness change if muscle
Relationship between muscle
activity is eliminated?
activity and stiffness
100 RTPM Pre - 0.432 (0.674) 100 RTPM pre - 1.063
20 Brisk
movement
60 Brisk
movement 70 RTPM Post - 0.155 (0.881)70 RTPM post – 1.001
Force Slow EMG Slow
Force (N)
Force (N )
40 40
EMG (uV)
10 40 moveme
Force (N)
movemen
t Force nt EMG 10 10
20 20 38 56 74 92 110 128 146 164 182 200 20 38 56 74 92 110 128 146 164 182 200
0 20 40 60 80 100 120 20 20
50 50
10
0 20 40 60 80 100 120
Angle (Degrees) Angle (Degrees)
Angle (Degrees) Angle (Degrees) Pre Pre
RTPM pre treatment Fast Flexor EMG pre treatment
Lin. Reg Pre Lin. Reg Pre
RTPM post treatment Slow Flexor EMG pre treatment Post Post
Linear Reg Post Linear Reg Post
Confounders (in brief)
In the context of spasticity I
decided to leave the
measurement of stiffness aside
and focus on the
measurement of muscle
activity
No Spasticity (~10%)
So what did muscle activity
look like
3
4. 24/09/2012
Lance was correct velocity There also position dependent
dependence existed ~ 20% activity ~ 30%
The combination of course ~ 40% Two anomalies~1%
Total Number of articles
Medline-314,Science direct-64 ,Web of science-309
So what did muscle activity
look like – very variable Total Number of articles read – 787
Relevant articles – 265
Literature Review – 47 Controlled trial – 204
SCS - 14
4
5. 24/09/2012
1. Spastic paralysis (this is a term I have
seen in the literature since 1890’s) Spasticity
2. The term is then used in the context of
Researcher
clinician
the positive symptoms in the
Patient
Nurse
Therapist
Carer
classification developed by Hughlings
Jackson
3. First form of a clinical definition Lance Muscle None Other
produced by Denny-Brown 1960’s
Tone
31% 35% 31% 3%
4. The Lance definition of the 1980’s
The assessment framework was
no better There was a definition …
• Clinically the
primary measure but this was not an agreed
is the AS (& MAS)
v an Wijck et al 2001. definition per se and it did not
inform measurement or
• The Tardieu
Method is clinical practice
growing in
popularity Haugh et al
2006.
Studying increased reflexes
Increased activity Spasticity
Mechanism
•Increased reflexes •Increased reflexes
•Spasticity •Altered tone
•Altered tone •Spasm & Clonus L1 L2 L1
k d L2
2
•Spasm & Clonus •Abnormal k k
•Abnormal movement EMG
movement patterns patterns & co- electrodes
& co-contraction contraction Goniometer l
D D
m*g*l*sin(
I B K mgl sin
5
6. 24/09/2012
Quantifying reflex excitability
Raw EMG Amplitude mk0 m Stretch Reflex Delay (Smooth) Outcome Main finding
Amplitude
3
5
2
mk1 m mk3 m Latency measure
0
Amplitude Greater in non-impaired subject p<0.05
1
Degree s, V
5
Volts (V)
0
Latency Latency shorter in stroke p<0.05
10
1
2 15
Rise time No difference
Duration
3 20
0 100 200 300
Time (ms)
400 500 600 700 0 100 200 300 400 500 600 700 Duration No difference
Time (ms)
Raw EMG
Rectified EMG Angle
Smooth EMG Smooth EMG
The lumping
Disordered sensori-motor control,
resulting from an upper motor
neurone lesion, presenting as
intermittent or sustained
involuntary activation of muscles
There was an attempt at splitting The start of the splitting - 1
(N.American Task Force) Spasticity
• Spastic hypertonia: Velocity dependent •Increased reflexes (Not necessarily
increase in hypertonia with a catch when abnormal)
a threshold is exceeded. (no abnormal •Altered tone
resting position) •Spasm
• Dystonic hypertonia: After testing the limb will return to fixed resting
posture that can vary with state of mind or attempted movement.
•Clonus
(stiffness is independent of direction) •Abnormal movement patterns & co-
• Rigid hypertonia: Resistance to passive movement is not velocity
dependent and no consistent abnormal posture is observed. contraction
(stiffness is independent of direction)
6
7. 24/09/2012
Altered tone The start of the splitting - 2
Spasticity
1. Resistance one feels when •Increased reflexes
stretching the joint •Altered tone
This is a confounded measure so •Spasm
cannot contribute to a definition
•Clonus
•Abnormal movement patterns & co-
2. Readiness of the muscle to act contraction
This is reduced and is no different
to the definition of paralysis or
weakness – so there is a problem
The start of the splitting - 3 The start of the splitting - 4
Spasticity Spasticity
•Increased reflexes •Increased reflexes
•Altered tone •Altered tone
•Spasm •Spasm
•A transient but continuous muscular contraction •Clonus
(cutaneous trigger) •A transient rhythmic / cyclical muscle contraction
•Clonus – attenuated if a stimulus is removed
•Abnormal movement patterns & co- (proprioceptive and/or cutaneous)
contraction •Abnormal movement patterns & co-
contraction
The start of the splitting - 5 The patterns of muscle activity –
Spasticity how do we define this?
•Increased reflexes An increase in the gain
•Altered tone and/or reduction in
•Spasm threshold of a phasic
•Clonus stretch reflex
•Abnormal movement patterns & co- demonstrated in a
contraction There is a need to resolve the relaxed muscle !
pathology and physiology
conundrum
7
8. 24/09/2012
Environment
SE
Evidence for an epiphenomenon
W0 W6 W12 W24 W32
Individual Muscle NF 1.1 0.97 0.73 0.74 0.7
activity at (0.2) (0.3) (0.2) (0.2) (0.1)
MC SP a slow F 1.1 1.1 1.4 0.82 1.7
stretch (0.4) (0.5) (0.6) (0.2) (0.6)
Task
Muscle NF 1.2 1.1 0.9 0.7 0.8
activity at (0.3) (0.3) (0.2) (0.1) (0.1)
a fast F 1.0 1.3 1.3 1.1 1.9
stretch (0.4) (0.6) (0.7) (0.3) (0.7)
Spasticity as disorder control
Capacity (some arbitrary units)
My funders
– Action Medical Research, UK.
– N.Staffs Medical Institute, UK.
– EU
– DoH
– Biometrics Ltd, UK
– Allergan, UK
Time (an arbitrary non-linear scale)
Time course and muscle changes
8