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In the assessment of motor function, it should be kept in mind that observations of the speed and strength of movements and of muscle bulk, tone, and coordination are usually more informative than the state of tendon re exes It is essential to have the limbs fully exposed and to inspect them for atrophy and fasciculations The next step is to watch the patient maintain the arms outstretched in the prone and supine positions; perform simple tasks, such as alternately touching his nose and the examiner s nger; make rapid alternating movements that necessitate sudden acceleration and deceleration and changes in direction, such as tapping one hand on the other while alternating pronation and supination of the forearm; rapidly touch the thumb to each ngertip; and accomplish simple tasks such as buttoning clothes, opening a safety pin, or handling common tools Estimates of the strength of leg muscles with the patient in bed are often unreliable; there may seem to be little or no weakness even though the patient cannot arise from a chair or from a kneeling position without help Running the heel down the front of the shin, alternately touching the examiner s nger with the toe and the opposite knee with the heel, and rhythmically tapping the heel on the shin are the only tests of coordination that need be carried out in bed The maintenance of both arms against gravity is a useful test; the weak one, tiring rst, soon begins to sag, or, in the case of a corticospinal lesion, to resume the more natural pronated position ( pronator drift ) The strength of the legs can be similarly tested, either with the patient supine and the legs exed at hips and knees or with the patient prone and the knees bent Also, abnormalities of movement and posture and tremors may be exposed (see Chaps 4, 5, and 6).

report less effective (as you can see there are multiple sales organizations to each product and this would expand the graph too much)

The examination is completed by observing the patient stand and walk An abnormality of stance and gait may be the most prominent or only neurologic abnormality, as in certain cases of cerebellar or frontal lobe disorder; and an impairment of posture and highly automatic adaptive movements in walking may provide the most de nite diagnostic clues in the early stages of Parkinson disease and progressive supranuclear palsy Having the patient walk tandem or on the sides of the soles may bring out a lack of balance and dystonic postures in the hands and trunk Hopping or standing on one foot may also betray a lack of balance or weakness, and standing with feet together and eyes closed will bring out a dis-

Bonds, 231 238 interest rates vs prices of, 233 US Treasuries, 231 233 yield curve for, 235 238 yield of, 234 235 Breakeven: for back spreads, 157 for long butter y spreads, 192 193, 195 for long risk reversals, 137 138 for short call options, 100 for short put options, 103 Broad-based indices, 214 215, 272 273 Brownian motion theory, 267 Bull call spreads, 126 131, 133 134 Butter y spreads, 191 204 advantage of, 196 double, 197 iron butter y, 200 203 long butter y, 195 200 long put butter y, 195 197

Testing of the biceps, triceps, supinator (radial-periosteal), patellar, Achilles, and cutaneous abdominal and plantar re exes permits an adequate sampling of re ex activity of the spinal cord Elicitation of tendon re exes requires that the involved muscles be relaxed; underactive or barely elicitable re exes can be facilitated by voluntary contraction of other muscles (Jendrassik maneuver) The

equilibrium that is due to deep sensory loss (Romberg test) Disorders of gait are discussed in Chap 7

Table 1-4 Brief neurologic examination in the general medical or surgical patient (performed in 5 minutes or less) 1 Orientation, insight into illness, language assessed during taking of the history 2 Size of pupils, reaction to light, visual and auditory acuity 3 Movement of eyes, face, tongue 4 Examination of the outstretched hands for atrophy, pronating or downward drift, tremor, power of grip, and wrist dorsi exion 5 Biceps, supinator, and triceps tendon re exes 6 Inspection of the legs during active exion and extension of the hips, knees, and feet 7 Patellar, Achilles, and plantar (Babinski) re exes 8 Vibration sensibility in the ngers and toes 9 Finger-to-nose and heel-to-shin testing of coordination 10 Gait

portal or some sort of enterprise portal, but here we will only be working with the results of the WAD

Subacute (over weeks)

Chronic (months to years)

In the diagnosis of disorders characterized by generalized cerebellar ataxia (affecting limbs, gait, and speech), the mode of onset

The details of the legend are very clear and consistent across the report The color choices are good, clear, and accurate As you can see, the final results of WAD reports are not only about the data but also about the presentation Many projects encounter issues and setbacks due to the customer being uncomfortable with the finished look of the report or being confused by the approach to the display A dashboard may not be well received due to issues with coloring or the look and feel Therefore, this is a good example of a finished product Finally, the additional tabbed page can be used for detailed reports or other activities such as alerts or documentation Tabbed pages make the display much more user friendly and more manageable to read There is a tremendous amount of information concerning the formatting and functionality of creating dashboards or any reports required for management We will discuss this information in 6 Another very good example of a finished WAD report is shown in the following illustration In this case, the customer is looking for a more consistent and static reporting view of the data As you can see, there are no additional options for drilldown on the screen other than buttons at the top that will execute changes to the current graphic This is also a very good option since most of the time business users both casual and executive want to be able to just click a button rather than doing the analysis process of right-clicking and

Intoxication with alcohol, lithium, barbiturate, phenytoin or other anticonvulsants (associated with dysarthria, nystagmus, and sometimes confusion; Chaps 42, 43) Diamox-responsive episodic ataxia (Chap 37) Childhood hyperammonemias (Chap 37) Postinfectious, with mild in ammatory changes in CSF (Chap 36) Viral cerebellar encephalitis (Chap 33) Hyperthermia with coma at onset (Chap 17) Intoxication with mercury compounds or toluene (glue snif ng; spray painting; Chap 43) Postanoxic with intention myoclonus Brain tumors such as medulloblastoma, astrocytoma, hemangioblastoma (usually with headache and papilledema; Chap 31) Alcoholic-nutritional (Chaps 41 and 42) Paraneoplastic, often with opsoclonus and speci c anticerebellar antibodies (particularly with breast and ovarian carcinoma; Chap 31) Creutzfeldt Jakob disease (Chap 33) Cerebellar abscess (Chap 32) Whipple disease (often with myoclonus and oculomasticatory movements) Sprue (gluten enteropathy) Multiple sclerosis Friedreich ataxia and other spinocerebellar degenerations; other hereditary cerebellar degenerations [olivopontocerebellar degenerations; cerebellar cortical degenerations (Chap 39)] Adult form of fragile-X syndrome Hereditary metabolic diseases, often with myoclonus (Chap 37) Childhood ataxias, including ataxia telangiectasia, cerebellar agenesis, and dyssynergia cerebellaris myoclonica of Ramsay Hunt (Chap 39)