Key Procedures For Diagnosing Ncls Clinical Assessment

Clinical features of NCLs include rapid progressive deterioration of vision, seizures, development of mental retardation, movement disorders, and behavioral changes.[7] Brain atrophy as documented by imaging studies, including magnetic resonance imaging (MRI), is most pronounced supratentorially and in the brainstem. Cere-bellar atrophy, which results in enlargement of the fourth ventricle without concomitant cerebral atrophy, may be an early sign of NCLs.[8,9]

Practically, the progressive development of signs and symptoms is variable over time. Having a clear diagnostic algorithm (Fig. 1) will facilitate the clinical workup and characterization of the genetic deficiency. A good clinical evaluation, by which each individual examiner is capable of assigning an accurate Clinical Coding Score (CCS)[2] to any NCL patient, should be applied in the neurological assessment. The symptoms that should be evaluated include age at onset, first/initial symptoms at onset, and clinical course such as vision loss/blindness, learning and speaking disabilities, difficulty/inability to walk, involuntary movements/lack of coordination, rigidity/increased muscle tone, behavioral problems, and seizures/convulsions. A neuropsychological assessment for NCL patients may include WISC-IV,[10] WRAML,[11] and NEPSY,[12] in addition to the standard Mental Status Examination.1-13-1

Getting Started With Dumbbells

Getting Started With Dumbbells

The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.

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