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Muscle Nerve 1994; 17: 1243-1249 - 120 - Fatigue F Cross References Calf hypertrophy; Cramp; Fibrillation; Lower motor neurone (LMN) syndrome; Myokymia; Neuromyotonia Fast Micrographia In “fast” micrographia cheap inderal 80mg overnight delivery, written letters are microscopic from the outset 80 mg inderal for sale, sometimes approximating to a straight line inderal 40 mg line, though produced at nor- mal speed without fatigue buy inderal 80mg cheap. This pattern has been observed in progres- sive supranuclear palsy and with globus pallidus lesions, and contrasts with the “slow” micrographia, writing becoming progressively slower and smaller, seen in idiopathic Parkinson’s disease. Journal of Neurology, Neurosurgery and Psychiatry 2002; 72: 135 (abstract) Cross References Micrographia Fatigue The term fatigue may be used in different contexts to refer to both a sign and a symptom. The sign of fatigue, also known as peripheral fatigue, consists of a reduction in muscle strength with repeated muscular contraction. This most characteristically occurs in disorders of neuromuscular junction transmission (e. In myasthenia gravis, fatigue may be elicited in the extraocular muscles by prolonged upgaze caus- ing eyelid drooping; in bulbar muscles by prolonged counting or speech causing hypophonia; and in limb muscles by repeated contrac- tion, especially of proximal muscles (e. Fatigue in myasthenia gravis is understood as a decline in the amount of acetylcholine released from motor nerve terminals with successive neural impulses, along with a reduced number of functional acetylcholine receptors (AChR) at the motor end-plates, due to binding of AChR antibodies and/or comple- ment mediated destruction of the postsynaptic folds. This may occur in multiple sclerosis (MS), post-polio syndrome, post-stroke syndromes, and chronic fatigue syndrome (CFS). In MS and CFS, fatigue may be a prominent and disabling complaint even though neurological examination reveals little or no clinical deficit. This type of fatigue is ill-understood: in MS, frequency- - 121 - F Femoral Stretch Test dependent conduction block in demyelinated axons has been sug- gested, as has hypothalamic pathology. Current treatment is sympto- matic (amantadine, modafinil, 3,4-diaminopyridine) and rehabilitative (graded exercise). Fatigue may be evaluated with various instruments, such as the Krupp Fatigue Severity Score. Drugs 2004; 64: 1295-1304 Cross References Dystonia; Hypokinesia; Hypometria; Micrographia; Weakness Femoral Stretch Test The femoral stretch test, or reverse straight leg raising, consists of extension of the hip with the knee straight with the patient lying prone, a maneuver which puts traction on the femoral nerve or L3 root and may exacerbate pain in a femoral neuropathy or L3 radiculopathy, perhaps due to a retroperitoneal hemorrhage. Cross References Lasègue’s sign Fencer’s Posture, Fencing Posture Epileptic seizures arising in or involving the supplementary motor area may lead to adversial head and eye deviation, abduction and external rotation of the contralateral arm, flexion at the elbows, and posturing of the legs, with maintained consciousness, a phenomenon christened by Penfield the “fencing posture” because of its resemblance to the en garde position. To avoid falling and to maintain balance the patient must “chase”the cen- tre of gravity, leading to an increasing speed of gait and a tendency to fall forward when walking (propulsion). A similar phenomenon may be observed if the patient is pulled backward (retropulsion). Festination is common in idiopathic Parkinson’s disease; it is asso- ciated with longer duration of disease and higher Hoehn & Yahr stage. Festination may be related to the flexed posture and impaired postural reflexes commonly seen in these patients. It is less common in sympto- matic causes of parkinsonism, but has been reported, for example in aqueduct stenosis. Festination as the lead- ing symptom of late onset idiopathic aqueduct stenosis. Journal of Neurology, Neurosurgery and Psychiatry 2002; 73: 599-600 Cross References Freezing; Parkinsonism; Postural reflexes Fibrillation Fibrillation was previously synonymous with fasciculation, but the term is now reserved for the spontaneous contraction of a single muscle fibre, or a group of fibers smaller than a motor unit, hence this is more appropriately regarded as an electrophysiological sign without clinical correlate. Cross References Fasciculation Finger Agnosia Finger agnosia is a type of tactile agnosia, in which there is inability to identify which finger has been touched when the eyes are closed, despite knowing that a finger has been touched; or inability to point to or move a finger when it is named; or inability to name the fingers (patient’s own fingers or those of another person). This is a disorder of body schema, and may be regarded as a partial form of auto- topagnosia. Finger agnosia is most commonly observed with lesions of the dominant parietal lobe. It may occur in association with acalculia, agraphia, and right-left disorientation, with or without alexia and difficulty spelling words, hence as one feature of Gerstmann syn- drome. Isolated cases of finger agnosia in association with left cor- ticosubcortical posterior parietal infarction have been reported. Since this causes no functional deficit, it may be commoner than reported. Archives of Neurology 1994; 51: 448-450 Cross References Agnosia; Autotopagnosia; Gerstmann syndrome Finger Drop - see WRIST DROP Finger-Floor Distance In patients with leg (+/− back) pain suspected of having lumbosacral nerve root compression, a finger-floor distance of > 25 cm when the patient bends forward and attempts to touch the floor with the fin- gers has been found an independent predictor of radiological (MR imaging) compression. Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression. Journal of Neurology, Neurosurgery and Psychiatry 2002; 72: 630-634 Cross References Lasègue’s sign “Finger-Nose Test” - see ATAXIA; CEREBELLAR SYNDROMES Fisher’s Sign Fisher’s sign is the paucity of facial expression conveying emotional states or attitudes (emotional facial paresis).

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For instance purchase 40mg inderal overnight delivery, in September of 1998 one Canadian community college held weekend workshops and courses on a variety of therapies discount 40mg inderal otc, including ear candling buy 80 mg inderal with amex, mystical healing gems effective 80 mg inderal, herbalism, homeopathy, Chinese medicine, and shiatsu massage (Mohawk College 1998:156–59). By 2003, the same college not only offered several workshops or courses in complementary therapies, but also provided a certificate programme in aromatherapy, and was in the process of developing a diploma programme in herbal medicine (Mohawk College 2003a, 2003b). There is also evidence that participation in alternative therapies in Canada is on the rise (Achilles et al. For example, Northcott and Bachynsky (1993:432) found that “annual usage of alternative health care therapies (other than chiropractic)... Likewise, the number of alternative and complementary therapists in Canada has increased, and it is estimated that there are approximately twelve thousand licensed alternative practitioners in Canada (Achilles et al. The number of actual alternative and complementary practitioners in Canada is impossible to determine, as many practitioners—such as aromatherapists or reiki practitioners— remain unregulated and undocumented. Clearly, alternative therapies are an important part of Canadians’ health care regimes and their use of these approaches to health care is deserving of deeper analysis. Introduction | 3 Despite the number of people participating in alternative approaches to health and health care, very few sociologists have examined individuals’ experiences in using these therapies. Rather than focussing on alternative practitioners or the therapies themselves, this book provides the reader with a detailed understanding of the subjective experiences of the Canadian user of alternative approaches to health and healing. I explore how and why the people who took part in this research come to use alternative therapies, the ideology that informs the alternative models of health and healing they espouse, and the impact on them of the ideology underpinning these models. The people who spoke with me sought out alternative health care in order to solve problems for which they found little or no redress in other quarters. They began using alternative therapies through a variety of different points of entrée, including encounters with friends, family members, and the media, among others. Once involved in using these therapies, they developed ever-expanding networks of alternative health care composed of alternative practitioners and lay users of alternative therapies. In participating in alternative health care, and in interaction with others who use it, these people began to take on alternative ideologies of health and healing. For some, these ideologies became a mechanism through which they transformed their subjective perceptions of health status for the better. Quite simply, despite experiencing what is serious physical disability or disease, these people are able to see themselves as healthy because they are engaged in the process of healing. Others became so enamoured of alternative ideology that they sought training to become alternative practitioners themselves. However, there are other, less beneficial, consequences to self and identity inherent in adopting these models of health and healing. For instance, while participation in these therapies allows these people a measure of control over their health care, adoption of alternative health and healing ideology means that they must assume total responsibility for any problems of ill health they experience. Moreover, persistent social inequality means that the benefits to self these people experience are not available to those Canadians without the financial and other resources necessary to participate in alternative approaches to health care. Furthermore, in all cases, these people had to manage the deviant identities they acquired through their use of alternative therapies. This perspective is particularly appropriate to the questions I address, as my intent is a subjectivist understanding of the experiences of lay people who use alternative health care. Symbolic interactionism was useful in this research, since what distinguishes it from structuralist approaches is its focus on the micro level of society, its concern with the subjective experiences of individuals in interaction, and its emphasis on individuals’ own understandings of reality as a basis for their actions (Blumer 1969). In giving meaning to symbols, the individual is able to interpret the actions of others, conceive his or her own course of action, and anticipate future actions. As individuals interact with each other, meanings become shared, thus allowing people to communicate with each other through the use of significant symbols, such as language, gestures, and appearance. Meaning is not inherent in symbols; rather, it is a negotiated and social product, therefore symbols can hold a multiplicity of meanings. Symbolic interactionism’s subjectivist orientation permits the researcher to gain insight into the processes by which individuals both create, and modify, meaning (Blumer 1969; Maines 1981). Moreover, a qualitative research design was the natural choice for this research, as it ensures that the focus remains on the individual, emphasizing “the value of the person’s own story” (Becker 1996:vi). Such a focus allowed me to form an interpretive understanding of the motives and meanings behind individuals’ participation in alternative approaches to health and healing (Becker 1966).

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I’ve learned to savour the moment order inderal 40 mg fast delivery, being in the present and taking care of myself discount inderal 40mg with amex. For example purchase 40mg inderal with amex, Randal explained how he and his personal environment had become unbalanced: “I’d come down with walking pneu- monia cheap 80mg inderal with mastercard. In yoga it’s called prana, in tai chi it’s called qi1 and qi means energy, that’s all it is. I think every thing is a balance, nature is a balance, we should be in balance with nature. As was the case with healing energy, those informants who believe health to be dependent on a balance between the self and the universe are also more likely to espouse alternative spiritual beliefs. In Lorraine’s words, Understanding the laws of the way that the universe works. I think of it as universal energy, and when we’re cast out as souls for this learning expe- rience, there’s one tiny spark. Control For most of the people who took part in this research, achieving wholeness and balance, in short, means control. Control in turn means two things: taking control and being subject to self-control. Taking control of the healing process also includes having options and having the autonomy to make decisions, a belief found in other research on lay perspectives on alternative therapies (Sharma 1992). Finally, being subject to self-control means controlling one’s thoughts, behaviours, and emotional reactions. For almost all the people who participated in this study, alternative health means taking control of the healing process. For some of these people this means wresting control away from medical professionals. For instance, Nora told me, “Even when people want to take responsibility, often they’re An Alternative Model of Health | 73 not allowed to because allopathic medicine really does have a lot to do with that. Take an active role in your own healing and with mainstream medicine they take that away from you. Some just had a general distrust of chiropractors and again they were trying to take the control out of my hands and putting it into their hands. For example, Laura told me that alternative “health is the freedom to make the choices that I’ve made,” and Lucy said this: If a doctor says: ‘This is what’s wrong, it’s serious, it’s chronic, it’s life- threatening,’ I may respect his education and his experience but he’s not infallible. Therefore, why would I not go and have one or two more other estimates to say: ‘Do you see this from the same perspective? It’s the method in which I go from health to death that I want to have a choice in. For still other informants, taking control means asking questions and getting second opinions. As Jane put it, “I think everybody needs to be a consumer and take responsibility for what they buy. You don’t buy a pig in a poke and you don’t buy a diagnosis without questioning it. I went out and asked more opinions and then I made a decision that I was not having that D and C. Montbriand and Laing (1991) argue that taking control of health and healing can also include the option of deciding to relinquish control to a practitioner. One informant, Laura, equated taking control with trusting her midwife enough to hand over control to her: I had so much trust and faith in her [the midwife] that during the delivery anything that she would have suggested I probably would have gone along with because I knew that what she would suggest would not be invasive 74 | Using Alternative Therapies: A Qualitative Analysis and would only be done if absolutely necessary. I felt like I was in control and had passed that control to her for that period of time. Finally, for many of these informants, taking control of your health means doing your own research (Sharma 1992). According to Jenny, “If I’m going to an acupuncturist, I have to spend as long learning about all the meridians.

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