Table of Contents
Case 1: On the Level
This is a case of an old patient called Macgregor who had the Parkinson’s disease. The Parkinson’s disease involves causative agents that affect the Central Nervous System in the area of the brain concerned with mobility. This part is called the midbrain or the mesencephalon controls the motor receptor cells that coordinate movement. The first symptom that Mr Macgregor suffers is what was manifested in his movement as tilted gait. According to him, his friends and family were wrong about his posture because he could not see or feel like he was tilted while he walked. His center of gravity is distorted. Macgregor could not see any form of disability in his system because he felt normal. His visual set was not yet affected by the disease. This is an early stage in which his condition was diagnosed. Upon experimentation to assess his condition, he was told to walk in a recorded camera session and later when he was shown the footage, he could not believe himself. The nervous breakdown as a result of the condition covers what the normal five senses of the body perceive as normal to effect that one cannot sense that anything is wrong with them. Since Macgregor’s sense of sight was not affected yet, it was easy to show him what was wrong with him by using a sense he had good use of. Patients with neurological problems may not perceive nor understand (at later stages) their condition and therefore explaining this to them may be difficult, as was the case of “the man who fell out of bed”
Macgregor’s condition was a language only understood by his body. The internal workings of the body, the balance and coordination of movement are preserves of the proprioception which is in turn largely under the auspice of the cerebellum part of the brain. The lack of body balance or coordinated movement is something that Macgregor’s body compensated very well through the manipulation of the Latissimus Dorsi muscles found at the back. The nature of this muscle which is by far the most flexible and self-adjusting muscle in the body is able to reorganize body balance and absorb weight shock in a way that allows individuals with Parkinson’s disease to feel no difference in the way they normally walk. This same principle is the breakthrough in which correctional measures are taken to help patients with the disease correct their posture since the disease has no cure. Macgregor’s body was able to adapt to a certain walking posture with a play of coordination between the proprioception and the Latissimus Dorsi Muscles. Even though there are three systems that are responsible for balance, namely the vestibular, proprioceptive and visual system, one of them can function to cover for the others should they malfunction. In Macgregor’s case, the proprioceptive nervous system worked for him since his vision had not been affected yet. As a correctional measure, Macgregor and Dr. Sacks came up with a correctional remedy that involved using the visual system to correct what was internally wrong by the constant exercise of the proprioceptive system. In this regard, the use of spirit-level fitted glasses helped Macgregor to have a consistent and accurate bench mark from which his internal motor receptor system would learn the external balance.
Case 2: The man who fell out of bed
This case involves a young man who goes to the hospital complaining of his less responsive hemiplegic limb. Of course he is not aware of what is happening to him but after some time the condition of his leg begins to manifest in severe loss of memory and near-hallucination tales of prank pulling. While on one hand he is convinced that someone grafted a leg on him, he cannot explain the loss of his original left leg. Such vague spaces in his mind are irreconcilable by merely pointing to the physical environment he is in because the problem is in his brain. His brain cannot process what the five external senses can relate to due to an inability to master individual joint movements. The cerebellum is once again in chaos as it cannot control nor acknowledge the leg as part of the rest of the body. When the young man initially falls asleep and then is attacked by a brainwave, everything seems to have changed in his worldview so that scores of events transpire until he is left with the aftermath of what he recalls as a bad but original joke. The mind at this point is trying to reconcile what has been decidedly left out in the normal processing and issuance of signals for limb coordination and since it cannot work out the motor receptor cells it seems stuck in a limbo and therefore the evasive course of action is to create a mystery surrounding the zero feedback coordination with the left leg. Possibly his case was a result of an illness or stroke, the basic origin for this kind of paralysis. This would mean that he was suffering from hemiparesis since it doesn’t seem to be severe as he can still establish conflicting information such as when he is told that the leg he has is his and yet he feels otherwise even though he wants to believe his doctor. The cerebrovascular accident or stroke is characterized by immobility of a certain area depending on the corticospinal part of the tract that is affected. The occasional sporadic muscle tensions, the unresponsive and uncoordinated body shaking are also part of hemiparesis (a mild form of hemiplegia) which the boy seemed to show upon examination.
Further, another assault experienced by the patient was a condition called Visual Agnosia. In addition to the patient being unable to make use of his leg, he cannot recognize that it is his. Visual Agnosia entails the inability of the brain to recognize and use a part of the body. In the brain, this damage occurs in the posterior occipital or the temporal lobe when stroke hits any or both of these places. The patient can in this case have a visual appreciation of what part of the body they feel they don’t have or cannot associate with their bodies. During pathological examinations patients can be asked to draw the object that they cant feel are part of their body or they can also be asked to give a description if they can’t draw. The experience is when patients, such as the young man in question, can give a vivid description or drawing of the ‘rejected body’ part the resulting type of Visual Agnosia iscalled Appreciative Visual Agnosia. This is what the young man was suffering from because he was able to vividly describe the part of the body he felt did not belong to him in such great detail that it was clear what he meant. The Occipital Lobe being the main VisualProcessingCenter of the Visual Cortex plays a great role in reconciling and interpreting the images that are sent to the brain from the eye. When this process is halted by the damage in that part of the brain the basic perception becomes a problem and therefore the eye cannot interpret what it sees. The process becomes complex when the Temporal Lobe has been damaged as well. Since the temporal lobe is involved in creating meanings (Semantics) to objects and therefore assigning permanent memory to objects as ‘seen’ by the brain, then explaining the present ‘unexplainable ugly’ leg attached to the young man’s body became hard. Luckily, the young man is still able to retrieve memories of what a leg looks like and therefore he is able to understand that first it is a leg but he cannot explain why it is or isn’t his. Because of these gaps in the brain, the brain begins to go through a compensatory process of selective attention to stimuli. Here the brain decides what it admits as part of the body in memory and what it rejects because the general harmony of visual-auditory memory coordination is lost due to the damaged brain parts. The ability of the brain to adjust to a stimuli or the lack of it forms basis for a very recent method of correcting or trying to avert the effects of stroke called brain plasticity method. The brain must come up with a formula of selective avoidance of otherwise resulting stressful irreconcilable stimuli with brain memory. This is why the young man incessantly wants to get rid of the leg because since it is not a welcome part of the body according to what has been ‘ordained’ by the brain, then it shouldn’t stay on his body.
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In conclusion, the need for a pathological analysis is so that doctors can establish the pattern of the disease or condition and to be able to tell the mitigating steps that can be taken in order to correct the situation. According to the patients in each case, they felt that they were okay and that the people around them were wrong about their conditions. The brain is the Central Nervous System that creates, controls and maintains memory and therefore ‘reality’ so to speak. The reality of the patients is distorted when a part or parts of their brains are distorted. The brains capacity to compensate for a defect has led to amazing discoveries in the way stroke and other brain defects are to be treated. From the invention of the McGregor’s ‘level’ glasses to the discovery of brain plasticity such as is the case in ‘the man who fell out of bed’ is a progress of medical discovery dependent on pathological examinations.
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