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Lesions along the primary motor pathway, UMN LMN NMJ M, are characterized by weakness or paralysis. We will see that the characteristics of the weakness are different in each instance; for example, UMN weakness has different characteristics from LMN weakness. Knowledge of these characteristics is fundamental to clinical neurology. Normal basal ganglia, cerebellar and sensory function is essential background activity of the nervous system for normal movement. Lesions in these parts of the nervous system do not produce weakness or paralysis, but make movement imperfect because of stiffness, slowness, involuntary movement, clumsiness or lack of adequate feeling. So we will be questioning and examining for weakness, wasting, stiffness, accidity, slowness, clumsiness and loss of feeling in our patient s left leg. This will help to identify in which component of the nervous system the fault lies. To make more sense of the patient s clinical problem, we have to know the basic anatomy of the neurological components, identi ed above, in general terms but not in every minute detail. This is shown on the next three pages.

24 We cannot offer more of the same and expect any different reception than we have experienced several hundred times in the past As a child in the late 1940s and early 1950s, the scourge of my childhood was polio It was a lurking evil monster that snatched victims away without rhyme or mercy and caused many parents sleepless nights The medical community responded Doctors and nurses and technicians tended those stricken and iron lungs were featured on posters and stamps as the best modern technology could offer to those afflicted Yet the answer to this plague did not come in the form of more doctors and nurses, or in the form of an improved iron lung It came, instead, from the hands and mind of Dr Jonas Salk, who produced a vaccine that made the disease ineffective in attacking its human targets.

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The GSM architecture designed in the 1980s was heavily in uenced by ISDN In the ISDN perspective, packet switching is to be used only for signalling Transmission of user data is limited to circuit As a consequence of this limited view, ISDN switches, and hence GSM switches, since they are usually derived from them, have a high capacity for circuit switching, and a small one for packet switching The latter was suf cient, however, so that the very low rate packet service called Short Message Service (SMS) was acceptable, but widely insuf cient for the emerging packet services, in particular for wireless access to the Internet The consequence of this was that those services could be offered only using a circuit to cross the switch, and, unfortunately, the A interface.

Copyright Thomas J. Lucier 2005. To customize this document, download it to your hard drive from Thomas J. Lucier s web site at www.thomaslucier.com/optionforms.html. The document can then be opened, edited, and printed using Microsoft Word or another popular word processing application.

The topic of one major phase 21 work item was to provide some improvement of this state of affairs, and that was GPRS It fell to SMG3 to study the system architecture for GPRS However, because the members of WPC, the group in which switching and routing are dealt with, were mainly ISDN experts, and because the experts sent for dealing with GPRS architecture were mainly Internet experts, WPC was considered by both parties as unsuited to study the item, and a special technical sub-group was created Other factors led in the same direction to estrangement between the original ISDN core of GSM and the GPRS work item One was the weight of in-the- eld equipment.

If we, as a profession, are to achieve breakthroughs of this magnitude we, too, must look toward the laboratories and not the wards The wards, like our case folders, are full of battles already lost We can and should deal with them, but the answers do not lie there The answers, if there are answers, will be found in our collective experience and our willingness to look outside the normal scope of our everyday activities Dr James D Watson, the co-founder of the double-helix theory of DNA research, has observed that intuition, conjecture, and experience have useful and appropriate roles in the development of even scientific theories, noting in an interview: I think you have to speculate If I have a good idea, I tend to believe it s true An idea is better than no idea that s the way good science works.

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