Als brisk reflexes12/24/2023 ![]() ![]() "As you take the history and examine the patient, you're testing your hypotheses," Chad says. And each may lead to the use of specialized technology. And the woman with double vision from weakened eye muscles may have had several appointments in the ophthalmology clinic hoping for the lenses that can correct her problem.īut when these trails haven't led to satisfactory diagnoses, an MDA neuromuscular clinic may at last bring the whole picture into view.ĭavid Chad, director of the MDA clinic at the University of Massachusetts Medical Center in Worcester, describes the diagnostic process as a series of tests of hypotheses.Įach hypothesis generates or eliminates suspects in the case. The fit-appearing young man may have spent months with a mental health professional trying to sort out why he can't seem to tolerate much exercise. The child whose speech is slow to develop may spend years with hearing and speech specialists before it's noticed that her facial muscles are weak from an infantile-onset muscular dystrophy. It's likely that a patient has at least seen a primary care physician or pediatrician beforehand, and, in many cases, the road has been very long indeed. Surveying the sceneĬhances are the neuromuscular disease specialist's office isn't the first stop for most patients. It takes modern technology and skillful investigators to figure out the culprit - the exact diagnosis. It's only when those questions are answered that chemical analysis of fingerprints, clothing fibers and DNA samples take their place in the solution of the crime.Ī similar process applies to determining a diagnosis from a collection of symptoms that could indicate any of several neuromuscular diseases. ![]() Who had access to the safe? Where was the security guard? What wealthy, jewelry-stashing guest was staying at the hotel? Who knew about her? What happened, and when, and who's responsible?Īlthough criminal investigations rely on computer searches, fingerprints, traces of material left at the scene and DNA analysis, these tools are used by human beings who apply a process of deductive reasoning that turns the spotlight on a progressively smaller number of suspects, until the true culprit is identified. The safe has been opened, and the hotel guests' jewelry and other valuables are missing. The scene is familiar to everyone who watches crime dramas. *Note: In the print edition of Quest, this article was titled "Rounding Up the Usual - and Not So Usual - Suspects." The diagnostic process in neuromuscular disease involves following many clues and rounding up the usual - and not so usual - suspects ![]()
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