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ci c critical studies, comprising all measurable psychologic functions such as attention, learning, memory, verbalization, calculation, transmodal sensory associations, etc are just now being undertaken Such handicapped persons present an immense challenge to neurologists, psychologists, and neuropathologists It is important to emphasize that only a small proportion of cases of mental retardation representing those with profound and severe de ciency can presently be traced to the congenital abnormalities of development that are reviewed in Chap 38 Indeed, when the brains of the severely retarded are examined by conventional histopathologic methods, gross lesions are found in approximately 90 percent of cases, and in fully three-quarters an etiologic diagnosis is possible Noteworthy is the fact that among the remaining 10 percent of the severely ( pathologic ) retarded, the brains are said to be grossly and microscopically normal.

segmental sensory impulses From these cells of termination, second-order axons connect with ventral and lateral horn cells in the same and adjacent spinal segments and subserve both somatic and autonomic re exes The main bundle of secondary neurons subserving pain sensation projects contralaterally (and to a lesser extent ipsilaterally) to higher levels; this constitutes the spinothalamic tract, discussed below In recent years, a number of important observations have been made concerning the mode of transmission and modulation of pain impulses in the dorsal horn and brainstem Excitatory amino acids (glutamate, aspartate) and nucleotides such as adenosine triphosphate (ATP) are the putative transmitters at terminals of primary A- sensory afferents Also, A- pain afferents, when stimulated, release several neuromodulators that play a role in the transmission of pain sensation.

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In other words, in this 10 percent of retarded, current technology does not enable the neuropathologist to delineate a lesion that had caused lifelong severe retardation Furthermore, the vast majority of the less severely retarded also lack a recognizable tissue pathology and have not exhibited any of the conventional signs of cerebral disease For this reason, some physicians have not regarded them as having disease of the brain, even though most informed individuals adhere to the idea that the brain, which is the organ of the mind, must be functionally incompetent The most acceptable view of the mildly affected group of retarded persons is that they represent the proportion of the population that is the opposite of genius On the Gaussian curve of human intelligence, they constitute the lowest 3 percent, the group that falls between 2 to 3 standard deviations (SD) below the mean (see Fig 28-4).

The reading specialist and the classroom teacher, who may have special preparation in teaching literacy, often work from different materials, so ensuring continuity and fostering the integration of classroom and special assistance are essential Reading specialists also consult frequently with parents on giving help and encouragement at home When there is time, reading specialists may work with high-achieving children for enrichment purposes Five- or six-year-olds who are advanced in language development often need special attention, support, and encouragement to stay interested because the regular pace of instruction in the classroom becomes monotonous and boring to them The trend in the rhetoric on reading, and on literacy in general, seems to be away from a hard-driving emphasis on mechanics and basic readers toward a wider use of children s literature, development of an interest in reading, and creation of relationships between a child s reading, writing, speaking, and listening.

Slower neurotransmission by C neurons involves other substances, of which the most important is the 11 amino acid peptide known as substance P In animals, substance P has been shown to excite nociceptive dorsal root ganglion and dorsal horn neurons; furthermore, destruction of substance P bers produces analgesia In patients with the rare condition of congenital neuropathy and insensitivity to pain, there is a marked depletion of dorsal horn substance P A large body of evidence indicates that opiates are important modulators of pain impulses as they are relayed through the dorsal horn and through nuclei in the medulla and midbrain Thus, opiates have been noted to decrease substance P; at the same time, exor spinal re exes, which are evoked by segmental pain, are reduced Opiate receptors of three types are found on both presynaptic primary afferent terminals and postsynaptic dendrites of small neurons in lamina II.

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