S. Topork. Missouri Valley College.

Patterning Therapy: Doman–Delacato Technique Patterning therapy was developed by G 25 mg indocin for sale. This therapy was based on the theory of recapitulation of species developed by Temple-Fay in the 1940s purchase 25mg indocin. Furthermore generic indocin 50 mg on line, doing the activity frequently will imprint it on the brain and stimulate the brain to develop the next higher function. Sensory integration and stimulation are included as well. In reca- pitulation theory in combination with the hierarchical development theory, children turn over first, then crawl, which stimulates walking with all four limbs. This four-limb walking then stimulates the brain to develop bipedal standing, in turn stimulating intellectual development. This protocol also includes stimulating children to make vocal sounds and specific sensory stimulation, somewhat similar to the Vojta technique. The concept of reca- pitulation comes from the belief that children start out moving first by crawl- ing like a worm, then moving like a fish, followed by walking on all fours like a quadruped animal, until finally reaching the human phase of biped walking. A unique aspect of the patterning approach is a heavy focus on do- ing the therapy for many hours each day, 7 days a week, every week of the year. Parents are taught the techniques and are encouraged to mount a com- munity effort to get volunteers into the home to continue the therapy for almost all these children’s waking hours. This therapy requires a huge com- mitment by parents and often raises the parents’ hopes above what is real- istic to accomplish. The patterning approach to therapy was especially popular in the 1960s and 1970s in California and in the Philadelphia area where there were spe- cially developed centers. There is no scientific evidence that this approach yields any of the claimed benefits. We have had many patients whose par- ents pursued patterning therapy for a time at some level, usually less than recommended by the original approach. There is no evidence to suggest that neurologic imprinting works; however, the extensive amount of passive range of motion many of these children receive seems to prevent contracture development. Clearly, however, the benefits are not worth the cost in time and commitment for families. During the height of patterning’s popularity, there were many severely disappointed parents, several ending in parental suicides. The high rate of inappropriate expectations among parents leading to severe problems led many medical societies to issue statements condemn- ing patterning therapy. Very little of this approach can be functionally applied, except to use it as an example of the damage that can be caused by an inappropri- ate therapy approach.

Tetrahydrobiopterin (BH4) is a cofactor phate (ATP) order indocin 50 mg line, selenium order indocin 25 mg with amex, and serine attached required for ring hydroxylation reactions (e safe indocin 25mg. This Synthesis of the amino acids: Eleven of the twenty common amino acids can be reaction uses two high-energy bonds. The codon recognized by the tRNA-selenocys- synthesized in the body (Fig. The other nine are considered “essential” and teine is a stop codon in the mRNA (UGA). Almost all of the amino acids that can be synthe- The secondary structure of the mRNA allows sized by humans are amino acids used for the synthesis of additional nitrogen-con- the ribosomes and tRNA to understand taining compounds. Examples include glycine, which is used for porphyrin and which UGA is a stop codon and which purine synthesis; glutamate, which is required for neurotransmitter and purine syn- requires the insertion of selenocysteine. Nine of the eleven “nonessential” amino acids can be produced from glucose plus, of course, a source of nitrogen, such as another amino acid or ammonia. The other two nonessential amino acids, tyrosine and cysteine, require an essen- tial amino acid for their synthesis (phenylalanine for tyrosine, and methionine for cysteine). The carbons for cysteine synthesis come from glucose; the methionine only donates the sulfur. The carbon skeletons of the 10 nonessential amino acids derived from glucose are produced from intermediates of glycolysis and the tricarboxylic acid (TCA) cycle (see Fig 39. Four amino acids (serine, glycine, cysteine, and alanine) are produced from glucose through components of the glycolytic pathway. TCA cycle intermediates (which can be produced from glucose) provide carbon for synthesis of the six remaining nonessential amino acids. Oxaloacetate pro- vides carbon for the synthesis of aspartate and asparagine. The regulation of individual amino acid biosynthesis can be quite complex, but the overriding feature is that the pathways are feedback regulated such that as the concentration of free amino acid increases, a key biosynthetic enzyme is allosterically or transcriptionally inhibited. Amino acid levels, however, are 712 CHAPTER 39 / SYNTHESIS AND DEGRADATION OF AMINO ACIDS 713 Glucose Glycine Phosphoglycerate Methionine (S) Asparagine Serine Cysteine TA Pyruvate Alanine Glutamine TA Aspartate Oxaloacetate Acetyl CoA Phenylalanine Tyrosine Citrate Glutamine Isocitrate TA α–Ketoglutarate Glutamate Glutamate semialdehyde GDH Proline Arginine Fig. Overview of the synthesis of the nonessential amino acids. The carbons of 10 amino acids may be produced from glucose through intermediates of glycolysis or the TCA cycle. The 11th nonessential amino acid, tyrosine, is synthesized by hydroxylation of the essential amino acid phenylalanine. Only the sulfur of cysteine comes from the essential amino acid methionine; its carbons and nitrogen come from serine. Transamination (TA) reactions involve pyridoxal phosphate (PLP) and another amino acid/ -keto acid pair.

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However buy discount indocin 75 mg, when cells use intermediates of the TCA cycle for molecules of electron-depleted CO2 are released discount 50 mg indocin visa. Subsequently indocin 25 mg with amex, a high- energy phosphate bond in GTP is generated from Glucose Fatty acids substrate level phosphorylation. In the Pyruvate remaining portion of the TCA cycle, succi- Ketone bodies nate is oxidized to oxaloacetate with the generation of one FAD(2H) and one NADH. CO2 The net reaction of the TCA cycle, which is the sum of the equations for individual Acetate Acetyl CoA Amino acids steps, shows that the two carbons of the CoASH acetyl group have been oxidized to two mol- OxaloacetateOxaloacetate + (4c)(4c) ecules of CO2, with conservation of energy NADH + H Citrate (6c)Citrate (6c) as three molecules of NADH, one of Malate (4c)Malate (4c) Isocitrate (6c)Isocitrate (6c) FAD(2H), and one of GTP. Fumarate (4c)Fumarate (4c) Tricarboxylic acid NADH + H+ FAD (2H) (TCA) cycle Succinate (4c)Succinate (4c) CO 2 αα-Ketoglutarate (5c)-Ketoglutarate (5c) GTP Succinyl-Succinyl- NADH + H+ GDP CoACoA (4c) CO2 Net reaction Acetyl CoA + 3NAD+ + FAD 2CO + CoASH + 3NADH + 3H+ 2 + GDP + P + 2Hi 2O + FAD (2H) + GTP Fig. The TCA cycle occurs in the mitochondrion, where its flux is tightly coordi- nated with the rate of the electron transport chain and oxidative phosphorylation through feedback regulation that reflects the demand for ATP. The rate of the TCA cycle is increased when ATP utilization in the cell is increased through the response of several enzymes to ADP levels, the NADH/ NAD ratio, the rate of FAD(2H) oxidation or the Ca2 concentration. For example, isocitrate dehydro- genase is allosterically activated by ADP. There are two general consequences to impaired functioning of the TCA cycle: (1) an inability to generate ATP from fuel oxidation, and (2) an accumulation of TCA cycle precursors. For example, inhibition of pyruvate oxidation in the TCA cycle results in its reduction to lactate, which can cause a lactic acidosis. The most common situation leading to an impaired function of the TCA cycle is a rela- tive lack of oxygen to accept electrons in the electron transport chain. THE WAITING ROOM Otto Shape, a 26-year-old medical student, has faithfully followed his diet and aerobic exercise program of daily tennis and jogging (see Chapter 19). He has lost a total of 33 lb and is just 23 lb from his college weight of 154 lb. His exercise capacity has markedly improved; he can run for a longer time at a Vitamins and minerals faster pace before noting shortness of breath or palpitations of his heart. Even his required for the TCA cycle test scores in his medical school classes have improved. In Riboflavin (FAD) addition to a low body weight, decreased muscle mass, glycogen, and fat Pantothenate (CoA) stores, she has iron-deficiency anemia (see Chapter 16). She has started to Thiamine gain weight, and is trying a daily exercise program. However, she constantly feels weak Biotin Mg2 and tired. On this visit to her nutri- Ca2 tionist, they discuss the vitamin content of her diet, and its role in energy metabolism. Fe2 Phosphate Al Martini has been hospitalized for congestive heart failure (see Chapter 8) and for head injuries sustained while driving under the influence of alco- hol (Chapters 9 and 10). He completed an alcohol detoxification program, O H enrolled in a local Alcoholics Anonymous (AA) group, and began seeing a psy- •• H C ••C~SCoA chologist.

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Stimulus Unlike neurons indocin 50 mg visa, neuroglia continue to multiply throughout life indocin 50mg on-line. Because of their capacity to reproduce order indocin 50 mg visa, most tumors of the nervous system are tumors of neu- roglial tissue and not of nervous tissue itself. What follows is a brief description of the electrical changes that occur as a resting neuron is + + + + + + + + – – + + stimulated and transmits a nerve impulse. This – – – – – ––– + + – resting potential is maintained by ions (charged particles) concentrated on either side of the membrane. At rest, the + + + + + + + + – – + + inside of the membrane is negative as compared with the Figure 9-8 A nerve impulse. In this state, the membrane is said to be polar- wave of depolarization followed by repolarization travels along ized. As in a battery, the separation of charges on either the membrane of a neuron. This spreading action potential is a side of the membrane creates a possibility (potential) for nerve impulse. THE NERVOUS SYSTEM: THE SPINAL CORD AND SPINAL NERVES 185 ical, or mechanical energy, causes specific channels in Checkpoint 9-7 An action potential occurs in two stages. In the first stage, the charge on the membrane reverses, and in the sec- the membrane to open and allow Na ions to flow into the cell. In the next step of the action potential, The Synapse K channels open to allow K to leave the cell. As the electrical charge returns to its resting value, the mem- Neurons do not work alone; impulses must be transferred brane is undergoing repolarization. At the same time that between neurons to convey information within the nerv- the membrane is repolarizing, the cell uses active trans- ous system. The point of junction for transmitting the nerve impulse is the synapse (SIN-aps), a term that port to move Na and K back to their original concen- trations on either side of the membrane so that the mem- comes from a Greek word meaning “to clasp” (Fig. However, this Axon of Mitochondria local electrical change in the mem- presynaptic Vesicles containing brane stimulates an action potential at neuron neurotransmitter an adjacent point along the membrane. End bulb of axon In scientific terms, the channels in the membrane are “voltage dependent,” Synaptic cleft that is, they respond to an electrical Postsynaptic stimulus. And so, the action potential neuron spreads along the membrane as a wave of electrical current. The spreading ac- tion potential is the nerve impulse, and Dendrite in fact, the term action potential is used to mean the nerve impulse. A stimulus is any force that can start an action po- tential by opening membrane channels Neurotransmitter and allowing Na to enter the cell.

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