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By Z. Brenton. Albion College.

The focus of the philosophical literature on the subject has been to judge the adequacy of the various concepts of disease and health cheap famvir 250mg with amex. Rather than undertake such a task with the idea of settling on one best definition order famvir 250mg visa, we need to better understand how these concepts are generated and in what situations they seem to work. This survey should afford ample evidence that conventional ideas of "efficiency" provide little compass for action given the conceptual terrain. We will find no literal, univocal core concept of disease, although some concepts seem to have wider applications than others. And the array of what are called "diseases" is a non-classical, radial category having central exemplary examples and exhibiting prototype effects. Given the enormous complexity and dynamism of the main disease models which will be outlined, the projection of purposes in clinical care simply cannot be mechanized in rigorous fashion. The idea that "costs" and "benefits" or even "costs" and "effects" are well formed concepts usable in formulating logical rules for decision making is founded on a fictional view of both the disease category and the nature of value. The first part of this chapter focuses on how Western medicine and popular culture, at least, operationally assume diverse concepts of disease. The several concepts of disease form a complex "cluster" of what George Lakoff calls idealized cognitive models. His example of such a cluster is the concept mother: Individual models in this cluster are as follows: (a) The birth model – The person who gives birth is the mother. Nevertheless, some of the concepts are, in most contexts, more central than others. When the cluster of cognitive models for "mother" acts as a source domain for understanding target domains metaphorically, the structure of this cluster suggests the meaningful metaphorical extensions. Like "mother," "game" and "business," "disease" is a cluster of related cognitive models at least close to those I have suggested below. The second part of the chapter details why the "disease" category must be understood as a radial category, extended by many devices from central prototypical members. If anything is close to foundational in this semantic structure, I will contend that it is "symptoms.

Circuit training involves a number of vigorous exercises that are often strength training in nature cheap 250mg famvir with visa. Circuit interval training (like group two ACSM [1995]) involves short duration bursts of activity interspersed with either rest periods buy generic famvir 250 mg line, or activity of a less intensive workload or active recovery (AR) sta- tions. Cardiac rehabilitation phase III programmes tend to favour the use of circuit interval training as it allows for individualisation and accommodates different needs and levels of ability. This individualisation can be achieved through: 108 Exercise Leadership in Cardiac Rehabilitation • changing the duration at each station; • changing the length of rest periods between each station; • altering the amount of resistance employed; • altering the speed and range of movements. When cardiac rehabilitation classes use circuit interval training, patients work between cardiovascular (CV) stations and active recovery (AR) stations. Each station has a fixed time period, which can range from 30 seconds to three minutes. CV stations should have the patients working up to the higher inten- sity of 75% HRmax, whereas AR are generally used to increase endurance of specific muscle groups, e. The ulti- mate aim is to increase the duration of exercise at the higher intensity exer- cise stations and reduce the duration at the lower intensity stations. This is achieved by encouraging an increase in the duration of the CV component and a reduction in AR time. To attain overload, an increase in CV time or an increase in exercise intensity can be used. It will depend on the patient whether time or intensity is the more appropriate method to attain increase in overload. This example shows how progression on a circuit with 5 CV and 5 AR sta- tions can be achieved by increasing time spent at each station: Circuit One (10 Minutes) AR – 1 minute CV – 1 minute Total CV time = 5 minutes Total AR time = 5 minutes Progresses to: Circuit Two (10 Minutes) AR – 30 seconds CV – 1 minute, 30 seconds Total CV time = 7. The advantage of this mode is that it is more representative of daily functional activity. In addition, it is easier for the exercise leader to construct a home Exercise Prescription 109 140 120 100 80 60 40 20 0 00:00:00 00:10:00 00:20:00 00:30:00 00:40:00 Time in minutes Figure 4. Free Aerobic This type of training involves the exercise leader performing the exercise at the same time as the group and teaching the group at the same time.

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Medial medullary syndrome This involves the hypoglossal nucleus generic 250 mg famvir with visa, corticospinal tract and medial lemniscus discount famvir 250mg mastercard. The lateral medullary syndrome is more likely to cause sensory symptoms, and the medial medullary syndrome more likely to cause motor syndromes: look again at Section 1. Since this presents as a disorder of the muscles of speech and swallowing, it is at first sight similar to a bulbar palsy, but being an upper motor neuron lesion, it is caused by a lesion on the opposite side. It is immediately above the lateral fissure, deep to the pterion, usually in the dominant hemisphere (normally the left). The main function of the glossopharyngeal nerve is the sensory supply of the oropharynx and posterior part of the tongue. Its other functions are the motor supply to stylopharyngeus; con- veying parasympathetic fibres part of the way to parotid gland and sensory supply from the carotid sinus, carotid body, and (sometimes) skin of the external acoustic meatus and tympanic membrane. Sensory fibres to pharyngeal plexus supplying mucosa of pharynx and posterior tongue. Thick line: parasympathetic fibres from inferior salivatory nucleus (ISN) to otic ganglion for parotid gland, and branchiomotor fibres to stylopharyngeus. Arterial components of the third arch form part of the common and internal carotid arteries thus explaining the carotid sinus innervation. Sensory fibres, including taste, from oropharynx, posterior tongue and carotid body chemoreceptors. The glossopharyngeal nerve (IX) 85 Branchiomotor fibres: from nucleus ambiguus to stylopharyngeus. Preganglionic axons from inferior salivatory nucleus to auricu- lotemporal nerve and otic ganglion. From variable portion of skin in external ear, axons pass in tympanic branch to main trunk of IX. Place a finger on the anterior part of the tongue (V) and then the posterior part (IX) to demonstrate this. The gag reflex is mediated by the glossopharyn- geal (afferent limb) and the vagus (efferent limb). It also transmits cutaneous sensory fibres from the pos- terior part of the external auditory meatus and the tympanic membrane. It supplies the gut tube as far as the splenic flexure of the trans- verse colon (roughly), and the heart, tracheobronchial tree and abdominal viscera. These fibres, though, are by no means essential to life, whatever others may tell you, since they can be cut, as in vagotomy.

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Aromatherapy Aromatherapy is usually a massage with essential oils; sometimes oils are heated and released into the atmosphere around you discount famvir 250mg fast delivery. Although purchase 250mg famvir, in COMPLEMENTARY THERAPIES AND MS 41 other forms of massage, an oil is often used as a lubricant during the massage, in aromatherapy specific oils are used for massage or heating and release, following an aromatherapy diagnosis of your state of mind and body. The oils are very concentrated, and should always be used in a carrier oil (such as sweet almond oil) during massage. Some of the oils should not be used if you are pregnant, or have certain other conditions, such as epilepsy, and it is crucial that you let your aromatherapist know about these. Although some of the more exotic and far-reaching claims for aromatherapy have never been tested, some people with MS have found it very relaxing and stress-reducing. Reflexology Reflexology is a therapy based on the idea that energy and other flows in the body are linked to, indeed terminate, at key points in the feet, providing a ‘map’ of key organs and systems in the body. It is believed that problems in all areas of the body can thus be identified and indeed treated through manipulation of the feet. Some people with MS have indicated that they have found this therapy helpful and relaxing, although there is no formal evidence that it affects the course of MS, or even major symptoms of the disease. Chiropractic Chiropractic is a long-standing approach to health based on a particular view of the ways in which the human body works and may be managed. Practitioners manipulate the bones, muscles and tissues, especially around the spine, to enhance health. In chiropractic, the focus is mainly the nervous system, and enhancing the blood supply around key tissues. Chiropractic is founded on the belief that a wide range of bodily pain and disease processes originate in abnormal nerve function. A course of treatment is usually composed of short sessions spaced out over several months. Chiropractic recommends itself particularly for back pain and persistent headaches. In very rare instances, manipulation of the spinal column can cause lasting damage, so always ensure that you consult a qualified chiropractor and that you discuss your MS fully before any treatment begins.

By Z. Brenton. Albion College.

The focus of the philosophical literature on the subject has been to judge the adequacy of the various concepts of disease and health cheap famvir 250mg with amex. Rather than undertake such a task with the idea of settling on one best definition order famvir 250mg visa, we need to better understand how these concepts are generated and in what situations they seem to work. This survey should afford ample evidence that conventional ideas of "efficiency" provide little compass for action given the conceptual terrain. We will find no literal, univocal core concept of disease, although some concepts seem to have wider applications than others. And the array of what are called "diseases" is a non-classical, radial category having central exemplary examples and exhibiting prototype effects. Given the enormous complexity and dynamism of the main disease models which will be outlined, the projection of purposes in clinical care simply cannot be mechanized in rigorous fashion. The idea that "costs" and "benefits" or even "costs" and "effects" are well formed concepts usable in formulating logical rules for decision making is founded on a fictional view of both the disease category and the nature of value. The first part of this chapter focuses on how Western medicine and popular culture, at least, operationally assume diverse concepts of disease. The several concepts of disease form a complex "cluster" of what George Lakoff calls idealized cognitive models. His example of such a cluster is the concept mother: Individual models in this cluster are as follows: (a) The birth model – The person who gives birth is the mother. Nevertheless, some of the concepts are, in most contexts, more central than others. When the cluster of cognitive models for "mother" acts as a source domain for understanding target domains metaphorically, the structure of this cluster suggests the meaningful metaphorical extensions. Like "mother," "game" and "business," "disease" is a cluster of related cognitive models at least close to those I have suggested below. The second part of the chapter details why the "disease" category must be understood as a radial category, extended by many devices from central prototypical members. If anything is close to foundational in this semantic structure, I will contend that it is "symptoms.

Circuit training involves a number of vigorous exercises that are often strength training in nature cheap 250mg famvir with visa. Circuit interval training (like group two ACSM [1995]) involves short duration bursts of activity interspersed with either rest periods buy generic famvir 250 mg line, or activity of a less intensive workload or active recovery (AR) sta- tions. Cardiac rehabilitation phase III programmes tend to favour the use of circuit interval training as it allows for individualisation and accommodates different needs and levels of ability. This individualisation can be achieved through: 108 Exercise Leadership in Cardiac Rehabilitation • changing the duration at each station; • changing the length of rest periods between each station; • altering the amount of resistance employed; • altering the speed and range of movements. When cardiac rehabilitation classes use circuit interval training, patients work between cardiovascular (CV) stations and active recovery (AR) stations. Each station has a fixed time period, which can range from 30 seconds to three minutes. CV stations should have the patients working up to the higher inten- sity of 75% HRmax, whereas AR are generally used to increase endurance of specific muscle groups, e. The ulti- mate aim is to increase the duration of exercise at the higher intensity exer- cise stations and reduce the duration at the lower intensity stations. This is achieved by encouraging an increase in the duration of the CV component and a reduction in AR time. To attain overload, an increase in CV time or an increase in exercise intensity can be used. It will depend on the patient whether time or intensity is the more appropriate method to attain increase in overload. This example shows how progression on a circuit with 5 CV and 5 AR sta- tions can be achieved by increasing time spent at each station: Circuit One (10 Minutes) AR – 1 minute CV – 1 minute Total CV time = 5 minutes Total AR time = 5 minutes Progresses to: Circuit Two (10 Minutes) AR – 30 seconds CV – 1 minute, 30 seconds Total CV time = 7. The advantage of this mode is that it is more representative of daily functional activity. In addition, it is easier for the exercise leader to construct a home Exercise Prescription 109 140 120 100 80 60 40 20 0 00:00:00 00:10:00 00:20:00 00:30:00 00:40:00 Time in minutes Figure 4. Free Aerobic This type of training involves the exercise leader performing the exercise at the same time as the group and teaching the group at the same time.

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Medial medullary syndrome This involves the hypoglossal nucleus generic 250 mg famvir with visa, corticospinal tract and medial lemniscus discount famvir 250mg mastercard. The lateral medullary syndrome is more likely to cause sensory symptoms, and the medial medullary syndrome more likely to cause motor syndromes: look again at Section 1. Since this presents as a disorder of the muscles of speech and swallowing, it is at first sight similar to a bulbar palsy, but being an upper motor neuron lesion, it is caused by a lesion on the opposite side. It is immediately above the lateral fissure, deep to the pterion, usually in the dominant hemisphere (normally the left). The main function of the glossopharyngeal nerve is the sensory supply of the oropharynx and posterior part of the tongue. Its other functions are the motor supply to stylopharyngeus; con- veying parasympathetic fibres part of the way to parotid gland and sensory supply from the carotid sinus, carotid body, and (sometimes) skin of the external acoustic meatus and tympanic membrane. Sensory fibres to pharyngeal plexus supplying mucosa of pharynx and posterior tongue. Thick line: parasympathetic fibres from inferior salivatory nucleus (ISN) to otic ganglion for parotid gland, and branchiomotor fibres to stylopharyngeus. Arterial components of the third arch form part of the common and internal carotid arteries thus explaining the carotid sinus innervation. Sensory fibres, including taste, from oropharynx, posterior tongue and carotid body chemoreceptors. The glossopharyngeal nerve (IX) 85 Branchiomotor fibres: from nucleus ambiguus to stylopharyngeus. Preganglionic axons from inferior salivatory nucleus to auricu- lotemporal nerve and otic ganglion. From variable portion of skin in external ear, axons pass in tympanic branch to main trunk of IX. Place a finger on the anterior part of the tongue (V) and then the posterior part (IX) to demonstrate this. The gag reflex is mediated by the glossopharyn- geal (afferent limb) and the vagus (efferent limb). It also transmits cutaneous sensory fibres from the pos- terior part of the external auditory meatus and the tympanic membrane. It supplies the gut tube as far as the splenic flexure of the trans- verse colon (roughly), and the heart, tracheobronchial tree and abdominal viscera. These fibres, though, are by no means essential to life, whatever others may tell you, since they can be cut, as in vagotomy.

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buy famvir 250mg visa

Aromatherapy Aromatherapy is usually a massage with essential oils; sometimes oils are heated and released into the atmosphere around you discount famvir 250mg fast delivery. Although purchase 250mg famvir, in COMPLEMENTARY THERAPIES AND MS 41 other forms of massage, an oil is often used as a lubricant during the massage, in aromatherapy specific oils are used for massage or heating and release, following an aromatherapy diagnosis of your state of mind and body. The oils are very concentrated, and should always be used in a carrier oil (such as sweet almond oil) during massage. Some of the oils should not be used if you are pregnant, or have certain other conditions, such as epilepsy, and it is crucial that you let your aromatherapist know about these. Although some of the more exotic and far-reaching claims for aromatherapy have never been tested, some people with MS have found it very relaxing and stress-reducing. Reflexology Reflexology is a therapy based on the idea that energy and other flows in the body are linked to, indeed terminate, at key points in the feet, providing a ‘map’ of key organs and systems in the body. It is believed that problems in all areas of the body can thus be identified and indeed treated through manipulation of the feet. Some people with MS have indicated that they have found this therapy helpful and relaxing, although there is no formal evidence that it affects the course of MS, or even major symptoms of the disease. Chiropractic Chiropractic is a long-standing approach to health based on a particular view of the ways in which the human body works and may be managed. Practitioners manipulate the bones, muscles and tissues, especially around the spine, to enhance health. In chiropractic, the focus is mainly the nervous system, and enhancing the blood supply around key tissues. Chiropractic is founded on the belief that a wide range of bodily pain and disease processes originate in abnormal nerve function. A course of treatment is usually composed of short sessions spaced out over several months. Chiropractic recommends itself particularly for back pain and persistent headaches. In very rare instances, manipulation of the spinal column can cause lasting damage, so always ensure that you consult a qualified chiropractor and that you discuss your MS fully before any treatment begins.