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causing misinterpretations of environmental stimuli (illusions) and misidenti cations of persons; these, at least in part, form the basis of hallucinatory experience in which the patient reports and reacts to environmental stimuli that are not evident to the examiner There is an inability to perceive simultaneously all elements of a large complex of stimuli, a defect that is sometimes explained as a failure of subjective organization These major disturbances in the perceptual sphere, traditionally referred to as clouding of the sensorium, are characteristic of delirium and other acute confusional states, but a quantitative de ciency may also become evident in the advanced stages of mental retardation and dementia More speci c partial losses of perception are manifest in the neglect syndromes (amorphosynthesis) The most dramatic examples are observed with right parietal lesions, which render a patient unaware of the left half of his body and the environment on the left side There are numerous other examples of focal cerebral lesions that disturb or distort sensory perceptions, each subject to neurologic testing; these are discussed in Chap 22 Viewed another way, these might be considered as limited types of loss of insight, but their close connection to spatial experience makes them more understandable as alterations of apperception in the spatialsensory sphere

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This command is used to specify whether the Broadcaster is to be started as a wizard If you want to start the Broadcaster as a wizard, you must also set the Distribution Type (DISTRIBUTION_TYPE) parameter You can choose from the following distribution types: Broadcast E-mail (MAIL) Broadcast to Portal (KM_EXPORT) Broadcast to Printer (PRINT)

of movement by virtue of its connections, via thalamocortical bers, with the corticospinal system and other descending cortical pathways 5 Several other parts of the cerebral cortex, particularly the premotor and supplementary motor cortices These structures are involved in the programming (ie, the sequencing and modulation) of voluntary movement 6 The prefrontal cortex These parts are involved in the planning and initiation of willed movement Fibers from the prefrontal cortex project to the supplementary and premotor cortex and provide the input to these more strictly motor areas Similarly, certain parietal cortical areas (superior parietal lobule) supply the somatic sensory information that activates the premotor and supplementary motor cortices and leads to directed movement In addition, other parts of the nervous system concerned with tactile, visual, and auditory sensation are connected by ber tracts with the motor cortex These association pathways provide their own sensory regulation of motor function The impairments of motor function that result from lesions in these various parts of the nervous system may be subdivided into (1) paralysis due to an interruption of lower motor neurons, (2) paralysis due to dysfunction of upper motor (corticospinal) neurons, (3) apraxic or nonparalytic disturbances of purposive movement due to involvement of association pathways in the cerebrum, (4) involuntary movements and abnormalities of posture due to disease of the basal ganglia, and (5) abnormalities of coordination (ataxia) due to lesions in the cerebellum The rst two types of motor disorder and the apraxic disorders of movement are discussed in Chap 3; extrapyramidal motor abnormalities are discussed in Chap 4; and disorders of coordination, in Chap 5 A miscellaneous group of movement disorders tremor, myoclonus, spasms, and tics and disorders of stance and gait are considered in Chaps 6 and 7 Impairment or loss of motor function due to primary disease of peripheral nerves and striated muscle or to a failure of neuromuscular transmission forms the subject matter of Chaps 46 to Chap 55.

The term paralysis is derived from the Greek words para, beside, off, amiss, and lysis, a loosening or breaking up In medicine it has come to refer to an abolition of function, either sensory or motor When applied to motor function, paralysis means loss of voluntary movement due to interruption of one of the motor pathways at any point from the cerebrum to the muscle ber A lesser degree of paralysis is spoken of as paresis, but in everyday medical parlance paralysis may stand for either partial or complete loss of function The word plegia comes from a Greek word meaning to strike, and the word palsy from an old French word that has the same meaning as paralysis All these words are used interchangeably, though generally one uses paralysis or plegia for severe or complete loss of motor function and paresis for partial loss

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