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Nonpatterned stimulation with 6–9 cats after a low thoracic spinal transection per- volts at 25–50 Hz at the L-2 level of the spinal form hindlimb stepping on a treadmill that is cord produced the most rhythmic unilateral antiviral used for rsv 200 mg molvir with amex, enabled by noxious stimulation below the lesion but occasionally bilateral hiv infection and seizures 200 mg molvir free shipping, alternating flexor-ex- and hip extension caused passively by the pos- tensor muscle activity hiv infection rate liberia purchase molvir in india. Bilateral activity was terior movement of the treadmill belt (see Ex- found only when the electrodes happened to perimental Case Studies 1–2). Peripheral stimulation of flexor re- duced rhythmic irregular flexor withdrawal flex afferents induced, slowed, or interrupted movements. The current probably stimulated dorsal and colleagues induced step-like locomotor ac- root fibers and, perhaps, dorsal column fibers. If considered in paral- sults of step training in the cat and in humans lel to the spinal transected cat experiments in after a complete SCI. After a low thoracic Experimental Case Studies 1–2, this rhythmic spinal cord transection, the segmental sensory activity suggests the possiblity that spinal auto- inputs discussed above have been used to train maticity in humans can be driven by locomo- cats183–186 and rats187 to step independently on tor-related sensory inputs that are recognized a moving treadmill belt over a range of speeds. Repetitive step training of a subject In people with a complete thoracic SCI who with a complete SCI may lead to greater am- are suspended with body weight support over plitude of the elicited EMG bursts and im- a moving treadmill belt while therapists move proved organization, as shown in Figure 1–7B. Electromyographic (EMG) activity from the flexor and extensor muscles of the legs in a subject with a com- plete thoracic spinal cord injury obtained during fully assisted treadmill stepping with 40% body weight support early (A) and late (B) after training. The level of weightbearing is shown at the bottom, highest during the phase of single and dou- ble-limb stance. The EMG about the ankle and knee muscles increased in amplitude, including the medial hamstrings (MH) and vastus lateralis (VL) at the knee and the soleus (SOL) and medial gastrocnemius (MG) at the ankle over the time of training, which suggests the recruitment of more motor units. The double burst that evolved in the tibialis ante- rior (TA) is typical of its normal pattern of firing. The rectus femoris (RF) came on only during stance and the iliopsoas (IL) fired at onset of swing (see Chapter 6 for details about normal firing patterns). Corticoreticu- ized using body weight–supported treadmill lospinal and corticovestibulospinal pathways training BWSTT) in people with incomplete are good candidates for leveraging the spinal SCI and hemiplegic stroke (see Chapter primitives. For walking, the SPINAL PRIMITIVES details of experiential practice in cats and the motoneurons and interneurons of the lum- rats198 and in humans174,179,195,199 are critical bar cord also participate in another type of or- for improving reciprocal stepping. As noted ganization that appears to simplify the problem earlier, important sensory inputs relate to the of motor contol. Bizzi and colleagues combined rate and degree of hip extension, the level of a spinal cord transection with electrical or limb weight bearing, the timing of interlimb chemical microstimulation of the ventral gray movements and of shifts in bearing weight at matter of frogs, rats, and nonhuman primates. Such inputs, provided stimulation of separate volumes of gray matter repetitively, may activate any conserved or- produced movements that the investigators ganization of primitives and CPG circuitry of quantified as force vectors. Within each vol- the cord and provide a clinical benefit (see ume or module, a discrete set of synergistic Chapters 6 and 9). This sensory information limb muscle contractions was elicited that di- also activates and reorganizes spared cortical rected the limb toward an equilibrium point. Functional neuroimaging stud- the leg in four positions within its usual work- ies reveal the details of the networks involved. By superimposing the to our knowledge of neuroplasticity after brain vectors of the force fields that were elicited and spinal cord lesions, are provided in Chap- across all the spinal modules, the investigators ter 3. Functional neuroimaging studies also re- calculated that the set of modules, which they veal the physiologic anatomy of the sensori- call primitives, stored the movements that motor network. This intrinsic spinal organization, ment representations in the primary sensori- which is likely to be present in man, permits motor cortex in remarkable detail. The primitives specific activities such as preparation for a presumably act together under the control of movement, internal generation of the move- supraspinal commands to create a rich reper- ment, and visualizing or imagining an action.
In some cases hiv infection icd 9 discount molvir 200mg otc, those rewards are vouchers for lower copayments on physician office visits or on prescriptions hiv infection effects buy generic molvir on-line. In other cases hiv infection barber order molvir online, they are coupons that can be redeemed at sites that offer patients with diabetes products not routinely covered by health benefits. In focus groups, consumers/patients indicated that having a mon- etary or quasimonetary reward was very important to them and would keep them focused on achieving better outcomes. However, these rewards did not have to be large, but rather simply achievable (thus echoing what physi- cians said was important for their own incentives). Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. It is not intended as a substitute for individual fitness, health, and medical advice. Please consult a qualified health care professional for individual health and medical advice. Neither McGraw-Hill nor the author shall have any responsibility for any adverse effects that arise directly or indirectly as a result of the information provided in this book. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. For more information, please contact George Hoare, Special Sales, at georgehoare@mcgraw-hill. TERMS OF USE This is a copyrighted work and the McGraw-Hill Companies, Inc. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. CONTENTS PREFACE vii 1 THE ELEMENTS OF YOUR ULTIMATE SUCCESS 1 2 ULTIMATE MOTIVATION 23 3 THE ULTIMATE NEW YORK BODY PLAN EXERCISE PROGRAM 39 4 THE ULTIMATE BODY NUTRITION PLAN 111 5 THE ULTIMATE BODY 14-DAY PLAN 133 6 THE ULTIMATE RECIPE COLLECTION 193 7 ULTIMATE BODY MAINTENANCE 235 8 RESOURCES 243 INDEX 249 TLFeBOOK PREFACE It has been a few years since I wrote my first book, Sound Mind, Sound Body. The more one knows about the process of writing a book, the more daunting is the task of writing another. As you will soon see, I did have lots to say, and the program I developed for the Ultimate New York Body Plan is short in duration but long in effect. I have approached this task very much like many others in my life—in a methodical, organized manner. When considering whether to take on the project, I pondered the same questions that concerned me the first time around: What are my objectives in writing this book?
Specific variations older adults are more likely to have acute and chronic illnesses may influence any of the chemical processes by which drugs that require multiple drugs or long-term drug therapy hiv infection unaids purchase discount molvir line. These peo- Body Weight ple may experience prolonged paralysis and apnea if given Body weight affects drug action mainly in relation to dose hiv infection rate in ethiopia molvir 200 mg with amex. These people may have hemolytic anemia Pathologic Conditions when given antimalarial drugs antiviral treatment order 200 mg molvir with visa, sulfonamides, analgesics, Pathologic conditions may alter pharmacokinetic processes antipyretics, and other drugs. In general, all pharmacokinetic processes are de- Ethnicity creased in cardiovascular disorders characterized by decreased blood flow to tissues, such as heart failure. In addition, the ab- Most drug information has been derived from clinical drug tri- sorption of oral drugs is decreased with various GI disorders. Interethnic variations became evident when drugs and ditions that alter plasma proteins. Metabolism is decreased dosages developed for white people produced unexpected re- in malnutrition (eg, inadequate protein to synthesize drug- sponses, including toxicity, when given to other ethnic groups. In general, African- American hypertensive clients respond better to diuretics or Psychological Considerations calcium channel blockers than to ACE inhibitors and beta Psychological considerations influence individual responses blockers. Another interethnic variation is that Asians usually to drug administration, although specific mechanisms are un- require much smaller doses of some commonly used drugs, known. A placebo is a including beta blockers and several psychotropic drugs (eg, pharmacologically inactive substance. Placebos are used in alprazolam, an antianxiety agent, and haloperidol, an anti- clinical drug trials to compare the medication being tested psychotic). Some documented interethnic variations are in- with a dummy medication. Attitudes and expectations related to drugs in general, a par- Gender ticular drug, or a placebo influence client response. They also influence compliance or the willingness to carry out the pre- Except during pregnancy and lactation, gender has been con- scribed drug regimen, especially with long-term drug therapy. Most research studies related to drugs have involved men, and clinicians have extrapolated the findings to women. Several reasons have been advanced for excluding women from clinical drug TOLERANCE AND CROSS-TOLERANCE trials, including the risks to a fetus if a woman becomes pregnant and the greater complexity in sample size and data Drug tolerance occurs when the body becomes accustomed analysis. However, because differences between men and to a particular drug over time so that larger doses must be women in responses to drug therapy are being identified, the given to produce the same effects. Tolerance may be acquired need to include women in drug studies is evident. Tolerance to stem from hormonal fluctuations in women during the men- pharmacologically related drugs is called cross-tolerance. Although this area has received little attention in For example, a person who regularly drinks large amounts of research studies and clinical practice, altered responses have alcohol becomes able to ingest even larger amounts before been demonstrated in some women taking clonidine, an anti- becoming intoxicated—this is tolerance to alcohol. If the per- hypertensive; lithium, a mood-stabilizing agent; phenytoin, an son is then given sedative-type drugs or a general anesthetic, anticonvulsant; propranolol, a beta-adrenergic blocking drug larger-than-usual doses are required to produce a pharmaco- used in the management of hypertension, angina pectoris, and logic effect—this is cross-tolerance. In addition, a significant per- Tolerance and cross-tolerance are usually attributed to acti- centage of women with arthritis, asthma, depression, diabetes vation of drug-metabolizing enzymes in the liver, which accel- mellitus, epilepsy, and migraine experience increased symp- erates drug metabolism and excretion. The increased symptoms may indicate to decreased sensitivity or numbers of receptor sites. Women with clinical depression, for example, may need higher doses of antidepressant medications premenstrually, if ADVERSE EFFECTS OF DRUGS symptoms exacerbate, and lower doses during the rest of the menstrual cycle. As used in this book, the term adverse effects refers to any un- Another example is that women with schizophrenia re- desired responses to drug administration, as opposed to ther- quire lower dosages of antipsychotic medications than men.
However lavender antiviral generic molvir 200 mg with amex, when the receptor- Spindle endings in the contracting muscle may dis- bearing muscles are activated tonically or phasically charge hiv infection lung purchase molvir once a day, but this occurs after the appearance of the to maintain balance their contraction is accompan- first EMG potentials and before the limb has actually ied by an increase in fusimotor drive sufficient to commenced moving hiv male yeast infection generic molvir 200 mg. Static fusimotor motoneurones the discharge of both primary and secondary spin- Possible role of the fusimotor system dle endings increases during voluntary contractions during normal movement (Figs. Further evidence indicating a of debate, and it is likely that its importance in the s action consists of an increase in static sensitivity, moment-to-moment control of movement differs in a decrease in the dynamic response of primary end- the cat and man – in part because of the species dif- ings to stretch (though this could be due to a change ferences discussed earlier (see pp. The view in the damping effect of the stiffness of muscle and that some movements can be initiated by first acti- tendon), and a loss of the pause in discharge that vating efferents is now rejected for both species, primaryendingsundergofollowingpassiveshorten- but the extent to which the fusimotor system pro- ing (Vallbo, 1973, 1974;Vallbo et al. In addi- vides a necessary support to voluntary contractions tion, there is an increase in the variability of spindle has not been clarified. Microneurography has been discharge, and the appearance of a negative serial used for ∼35 years, but in this time we have learnt a correlation between successive interspike intervals lot about what the fusimotor system does not do and (Burke, Skuse & Stuart, 1979), something that is a relatively little about its essential contribution to the feature of s drive (see Matthews & Stein, 1969; control of human movement. Role of afferent feedback Dynamic fusimotor motoneurones Is movement possible without afferent feedback? There is some evidence that d drive is increased in addition to s (Kakuda & Nagaoka, 1998). How- Movement is possible without any afferent feed- ever, the study compared the dynamic responses to back from the contracting muscle. This has been stretch of spindle endings in relaxed and contracting demonstrated in patients with large-fibre sensory muscles. Subjects were still able to activate motor axons directed to acutely dener- vated muscles and could voluntarily modulate their Skeleto-fusimotor motoneurones firing rates. There is also some evidence that voluntary activity activates motoneuronesinadditionto motoneu- Necessity for afferent feedback rones during wrist extension (Kakuda, Miwa & Nagaoka, 1998). This finding relied on the use of However, in the absence of afferent feedback, sub- spike-triggeredaveragingtodefineanEMGpotential jects were unable to maintain a steady discharge of closely linked to the afferent spikes, a technique that motoneurones, and the discharge rates in weak, Motor tasks – physiological implications 137 moderate and strong contractions were less than merely indicates that the nervous system will always those reached in control experiments on the same compensateaswellasitcanbeforethesystembreaks subjects. Afferent feedback is also critical when there Speculations on the functional role of drive areunexpecteddisturbancestomovement,suchthat in various motor tasks there is a mismatch between the intended and the achieved movement. Disturbances to the expected Accepting that muscle afferent feedback is critical movement trajectory may be external (due, e. Someformoffeed- dle responsiveness and, in particular, an ability to back is necessary for skilled movement particularly make such adjustments independently of the drive when in novel circumstances, such as walking over on motoneurones. Allmovements are learnt the above data do not identify whether the neces- While this book focuses on spinal circuitry and its sary feedback is of cutaneous, muscle or joint (or role in movement, it should be remembered that even visual) origin. It is likely that the inputs from muscle spindles are sensory receptors, that they all appropriately responding mechanoreceptors are project to higher centres including the sensorimo- integrated to provide a consistent view of the pre- tor cortex, and that they contribute significantly to vailing circumstances and that all can play a role kinaesthetic sensations. It is likely that the impor- in shaping the compensatory motor response. The tance of drive involves more than its spinal reflex evidence is cogent for cutaneous and muscle affer- role. Much infor- Lower-limb muscles mation about the role of different afferent inputs has come from removing individual afferent cues by Contractions of lower-limb muscles are usually blocking specific nerves or from artificially boosting weight-bearing and often cyclical, often eccentric. These are circumstances when create an artificial environment and could give a dis- the co-activated drive can represent a powerful torted view of the importance of different afferent input to muscle spindle endings (see Chapter 11, inputs. This does not mean that the excluded cues the muscles of the hand and forearm are required to were not important or that there was redundancy. It perform discrete manual tasks, while more proximal 138 Muscle spindles and fusimotor drive upper-limb muscles have a load-bearing and limb- manual task have been unsuccessful.
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