ANS & Sensory Considerations in Neurorehab Flashcards
what system controls the ANS
limbic system
what is the role of the hypothalamus
initiation motor activity for meeting homeostasis needs, ANS functions
what is the role of the hippocampal formation
memory formation
what is the role of the amygdala
emotional memory
what are notable limbic system structures in the brain
hypothalamus
hippocampal formation
amygdala
how is an emotional memory different from a regular memory
emotional memory can sometimes be more powerful
- and can elicit ANS response
what does the limbic system have the ability to affect (4)
arousal
participation
learning
compliance
how is the limbic system set up structurally
complex network w multiple interneurons
- linked to association areas in cortex for all sensory systems
what are 3 functions of the ANS
control activity of smooth ms, cardiac ms, glands
regulation and coordination of visceral activity
balance of sympathetic and parasympathetic responses appropriate to situation for homeostasis (ie fight or flight, response to stress)
what systems are required for survival
ANS
sensorimotor
limbic
describe the physiological reaction you see in a ANS sympathetic response (5)
hyper-vigilant, pupils dilate
BP, HR, and RR inc
sweating
inc blood flow to ms, dec to GI and skin
inc glucose production and release
why do you want to inc glucose production and release in an ANS sympathetic response
need energy and sugars to do whatever we need to do
describe the physiological reaction you see in a ANS parasympathetic response (5)
dec awareness of environment
pupils constrict
BP, HR, and RR dec
sweating stops
inc blood flow to GI tract, relax ms
what triggers a sympathetic ANS response
perceived or actual threats
what might you observe in a pt’s behavior after a sympathetic ANS response to perceived or actual threats
anxiety
agitation
irritability
aggression
what should you monitor for in pts
signs of sympathetic response during treatment
- changes in ANS function may be related to health condition rather than threats
- assess environmental/sensory factors inducing physiological stress
how does a pt’s ANS factor into a PT’s treatment
modify PT treatment to provide homeostasis
- do you need to decompress the sympathetic ?
what are 6 techniques for dec sympathetic response
- slow, continued effleurage of paravertebrals
- slow, smooth, pain free PROM or AAROM
- maintained deep pressure on abdomen, palms, soles of feet or skin above upper lip
- deep breathing exercises
- craniosacral manipulation
- progressive ms relaxation
what is ms scanning
tighten a ms and then relax it
what is included in the sensory systems
auditory
visual
vestibular
tactile/exteroreceptors
proprioception
- ms spindle
- golgi tendon organ
- joint receptors
what proprioceptive strategies can dec a sympathetic response
inc pressure
joint approximation
what can ringing in your ears be indicative of
equilibrium path
what is turning volume down to read a sign when driving an ex of
regulating sensory input
what is the auditory system connected to and what are the implications of this
vestibular system - CN VIII
- auditory stim may cause problems w equilibrium
where is the auditory cortex
temporal lobe
what function occurs in the auditory cortex
ability to process verbal commands
collaterals form the auditory cortex synapse where
RAS (reticular activating system)
cerebellum
many auditory association centers
what response do soft, steady sounds elicit
parasympathetic activation
- calming
- dec tone
what response do loud, fluctuating tones elicit
sympathetic activation
- inc arousal
- inc ms tone
what impact can extraneous noise have
can overwhelm or agitate
what % of CNS afferent and efferent fibers are visual system
38% of all
where is visual cortex located
occipital lobe
what function happens in the visual cortex
ability to perceive visual stimuli, detect movement and orientation of body parts in space (visual proprioception)
what connections does the visual cortex have
vast interneuronal connections
- thalamus
- RAS
- cerebellum
- cortical association pathways
what do the vast interneuronal connections of the visual system impact
ms tone
balance
emotion
level of arousal
how is vestibular stimuli relayed within the vestibular structures
peripheral vestibular apparatus
- mechanoreceptor w/i inner ear
afferents via CN VIII to CNS
what are specific structures in the peripheral vestibular apparatus and what are their functions
otoliths (saccule and utricle)
- linear movements & orientation of head relative to gravity
semicircular canals
- detect angular acceleration
how do slow, sustained, rhythmical movements (ie rocking) impact the vestibular system
dec ms tone and level of arousal
calming
otolith activation
how do fast, arrhythmical, spinning motions impact the vestibular system
inc tone
inc arousal level
inc motor response
semi-circular canal activation
what systems is the vestibular system highly connected to
proprioceptive
extrapyramidal motor
how is posture impacted by vestibular system
vestibular system affects postural tone and control
how does vestibular system impact the ANS
bp changes in response to position changes
what system is involved w tactile exteroceptors
spinothalamic system
DCML vs spinothalamic: touch info
DCML - more discriminative info
spinothalamic - more gross, travels slower
what response is the spinothalamic system responsible for
primitive, protective responses
- like pain
what type of touch can the spinothalamic system detect
poorly localized light touch
afferents from the spinothalamic system synapse with what
reticular formation
limbic system
ANS regulators
what is activated from exteroceptor stimulation
both ANS and sensory systems simultaneously
what dictates the ANS response elicited when ANS is simultaneously activated by exteroceptor stim
type of application effects response of ANS
what are ways to promote exteroceptor facilitation (2)
quick swipe, stroke
quick ice - more noxious
what are ways to promote exteroceptor inhibition (4)
slow stroking
neutral warmth
prolonged ice / ice massage
maintained pressure
where are proprioceptors found
ms spindle
GTO
joint receptors
what do proprioceptors connect to and what is the importance of these connections
cortex, brainstem, and cerebellum
important - modulate relevance of afferent info
what are proprioceptors important for
motor learning and adaptation
what is located in ms spindle and GTO
stretch receptors
- monitor length and tension
the response elicited from stretch receptor stim is dependent on what
rate and degree of lengthening
what are techniques to promote a faciliatory proprioceptive response (4)
quick stretch
tapping
vibration
graded resistance
what is a technique to promote an inhibitory proprioceptive response
prolonged stretch or maintained pressure
what are techniques for distraction of joint receptors (3)
manual
weights
gravity
(open chain)
what does distraction at joint receptors facilitate
agonist flexor response
how can you promote approximation at joint receptors (4)
manual compression
jamming/pounding
weights
gravity
(closed chain)
what does approximation at the joint receptors facilitate (2)
postural extensor response
co-contraction for inc stability in WB
how can joint approximation techniques be changed to be more faciliatory or inhibitory
faciliatory - more intervals, consistently jamming joint together
inhibitory - constant deep pressure
what are 5 sensory considerations given the role of PT
- part of sensory environment
- promote homeostasis
- constantly monitor & modify sensory environment to achieve desired response
- provide appropriate sensory experiences
- augmented therapeutic intervention - external input to facilitate desired motor output - critical to promote motor learning by dec sensory stim once skill acquired
what are 4 questions to ask in a problem-solving approach
- what can alter state of ANS
- what sensory systems are available
- what techniques will influence CNS and thereby affect motor output
- what input and/or environmental factors will promote homeostasis, motor performance, and learning
what ab ANS will impact pt treatment
status and functioning
what do sensory inputs have a significant impact on
ANS
motor performance
why do we want to promote homeostasis in pts
optimal pt participation and performance
how and why do we want to manipulate sensory inputs
how - affects ANS, motor status, mood
why - optimize outcomes and learning
