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ALS > Block 5 > Flashcards

Block 5 Flashcards

1
Q

what are ADLs? (2)

A

(activites of daily living)
- everyday tasks, functional activites
- can be personal, locomotion, work, leisure

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2
Q

what is a disabled person?

A

person with an impairment who experiences a disability

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3
Q

what is disability?

A

result of negative interactions between a person with an impairment and their actions

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4
Q

what is an impairment? (2)

A
  • illness, injury or condition that causes a loss of function
  • can be functional, physiological or psychological
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5
Q

what is the role of a physiotherapist?

A

assessing physical impairment, goal setting and management

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6
Q

what is the role of an occupational therapist? (4)

A
  • functional assessment
  • goal setting
  • QoL
  • ADLs
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7
Q

How do you assess ADLs? (6)

A
  • observation
  • self report
  • asking carefully worded questions
  • clinical examination
  • validated questionnaires
  • lab tests for conditions - ECGs
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8
Q

what are the aims for an ADL assessment? (4)

A
  • pain free
  • full muscle power
  • achieve normal range of motion
  • full function
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9
Q

what are some examples of global outcome measures? (5)

A
  • Barthel Index (1988)
  • Functional Assessment Measure
  • SF36
  • EQ-5D-5L
  • Health Assessment Questionnaire (HAQ)
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10
Q

what outcome measures are used for back pain? (2)

A
  • Roland and Morris Disability Questionnaire
  • Oswestry Disability Index
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11
Q

what are the levels of outcome management? (4)

A
  • individual patient level
  • service level
  • multidisciplinary team level
  • organisational level
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12
Q

how much do falls cost the NHS per year?

A

£2.3 billion

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13
Q

what are the two different approaches to disability?

A
  1. traditional medical model - problem and recovery are a matter for healthcare
  2. biopsychosocial model - partly a matter for health care but also of the individuals own efforts and behaviours
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14
Q

which approach is most recommended for back pain?

A

biopsychosocial

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15
Q

what is human locomotion?

A

moving from one place to another

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16
Q

what are the disadvantages of being bipedal? (2)

A
  • biomedical challenge of stability, maintaining efficiency
  • specialisation needs
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17
Q

what is the gait cycle?

A

period from initial contact (heel strike) of one limb until next time the same heel hits the ground

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18
Q

what are the two phases of the gait cycle?

A
  1. stance phase
  2. swing phase
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19
Q

what is a step?

A

distance from one heel strike to another on the opposite leg

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20
Q

what is a stride?

A

distance from one heel strike to the same foot making contact with the ground

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21
Q

what is a stride equivalent to?

A

1 gait cycle

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22
Q

what % of the gait cycle is the stance phase?

A

60%

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23
Q

what % of the gait cycle is the swing phase?

A

40%

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24
Q

what is a walking pattern?

A

having one foot on the ground at all times

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25
Q

what is a running pattern?

A
  • at some point during gait both feet are off the ground simultaneously
  • series of controlled steps
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26
Q

what is a double float?

A

when both feet are off the ground

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27
Q

what are the joints of the lower limb? (5)

A
  • ball and socket
  • hinge
  • plane
  • condyloid
  • sydesmosis
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28
Q

what are the functional units responsible for muscle contraction?

A

sarcomeres

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29
Q

what are agonists?

A

cause a movement through contraction

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30
Q

what are antagonists?

A

oppose a movement

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31
Q

what are synergist muscles?

A

perform or help perform the same motion as the agonist or stabilise the movement

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32
Q

what is concentric contraction?

A

muscle length shortens when contracting

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33
Q

what is eccentric contraction?

A

muscle length increases when contracting

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34
Q

what is isometric contraction?

A

no change in muscle length when contracting

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35
Q

what is the role of tendons? (2)

A
  • attach muscle to bones
  • good for force transmission, elasticity, energy storage and release
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36
Q

what is the role of ligaments? (2)

A
  • attach bone to bone
  • stability, excessive movement and shock absorption
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37
Q

what are tendons and ligaments composed of?

A

collagen fibres

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38
Q

what are the functions of the nervous system in relation to locomotion? (5)

A
  • motor control
  • sensory feedback
  • reflexes
  • co-ordination
  • gait control
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39
Q

what is the role of the primary motor cortex?

A

initiating motor control

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40
Q

what is the role of the cerebellum? (3)

A
  • fine tuning motor control
  • co-ordinating muscle activity
  • maintaining balance in gait
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41
Q

what is the role of the basal ganglia? (2)

A
  • co-ordination and modulation of muscle activity
  • initiation and refinement of movements
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42
Q

what is the role of the brainstem?

A

relay station for sensory motor pathways travelling between brain and spinal cord

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43
Q

what are central pattern generators?

A

neural circuits in the spinal cord that generate rhythmic, repetitive patterns of motor activity

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44
Q

what do muscle spindles sense?

A

stretch and speed of the stretch

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45
Q

what do Golgi tendons sense?

A

tension

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46
Q

what do joint receptors sense?

A

joint stretch and acceleration

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47
Q

where is the body centre of gravity positioned? (2)

A
  • pelvis
  • mid-line anterior to 2nd sacral vertebrae
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48
Q

what is stability determined by?

A

the relationship between the base of support and position of the total body centre of gravity

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49
Q

what is the ankle strategy?

A

body leans backwards/forwards by plantar/dorsi flexion to create opposite motion to bring CoM back

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50
Q

what is coxa vara?

A
  • decreased angle <120 degrees of femoral neck
  • results on ‘duck waddle gait’
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51
Q

what is coxa valga?

A
  • increased angle >140 degrees
  • associated with neuromuscular disorders e.g. cerebral palsy
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52
Q

what is achilles tendinitis?

A

overuse of achilles tendon

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53
Q

What is plantar fasciitis?

A

inflammation of plantar fascia

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54
Q

what is pet planus?

A

-‘fallen arches’
- seen in obese patients who stand for a long period of time

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55
Q

what are the subdivisions in the stance phase? (5)

A
  1. initial contact - heel strike
  2. loading response - flat foot
  3. midstance
  4. terminal stance - heel off
  5. preswing - toe off
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56
Q

what are the subdivisions in the swing phase?

A
  1. initial and mid swing
  2. terminal swing
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57
Q

what impacts gait? (2)

A
  • structural damage
  • aging
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58
Q

what is antalgic gait?

A
  • any gait that reduces loading by decreasing stance phase time to avoid pain.
  • e.g. stone in shoe
  • on painful side there is a short stand, long swing and lengthened stop
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59
Q

what is ataxic gait?

A
  • unsteady, unco-ordinated walk
  • associated with problems with the cerebellum
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60
Q

what is parkinsonian gait?

A
  • involuntary moves with short, accelerating steps seen on tiptoes
  • associated with basal ganglia
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61
Q

what is myopathic gait?

A
  • waddle type gait
  • associated with muscular diseases
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62
Q

what is neuropathic gait?

A
  • high stepping
  • associated with peripheral nerve damage
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63
Q

what is hemiplegic gait?

A
  • affected leg dragged
  • associated with motor impairment affecting one side of the body
  • associated with strokes
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64
Q

what is diplegic gait?

A
  • scissor gait
  • associated with cerebral palsy
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65
Q

what is the outside bone called?

A

cortical/compact

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66
Q

what is the inside bone called?

A

trabecular bone/cancellous/spongy

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67
Q

what are either ends of the bone called?

A

epiphysis

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68
Q

what is the middle bone called?

A

diaphysis

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69
Q

what is connective tissue?

A

diverse group of cells in the ECM

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70
Q

what fibres make up the ECM? (3)

A
  • collagen
  • reticular
  • elastic fibres
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71
Q

what ground substance make up ECM? (4)

A
  • hydroxyapatite
  • proteoglycans
  • multi adhesive glycoproteins
  • glycosaminoglycans (GAGs)
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72
Q

what predominantly makes up loose connective tissue? (2)

A
  • ground substance
  • some fibres + cells
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73
Q

what predominantly makes up dense connective tissue? (2)

A
  • fibres
  • some ground substance
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74
Q

what are the two types of dense connective tissue?

A
  • irregular - found in dermis, lymph nodes and periosteum
  • regular - found in tendons, ligaments
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75
Q

what are the three types of cartilage?

A
  • fibrocartilage
  • elastic
  • hyaline
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76
Q

what is a key feature of hyaline cartilage? (2)

A
  • highly hydrophilic
  • this creates swollen cushioned tissue
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77
Q

what is a key feature of fibrocartilage? (2)

A
  • high proportion of EC fibres
  • found in menisci in the knee
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78
Q

what is a key feature of elastic cartilage? (2)

A
  • high proportion of elastin in EC fibres
  • found in the external ear
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79
Q

what is bone made up of?

A

organised collagen fibres

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80
Q

what is an individual layer of bone called?

A

lamellae

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81
Q

what is a concentric circle of bone called?

A

osteon

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82
Q

what are the functions of bone cells? (3)

A
  1. osteocytes - within bone
  2. osteoclasts - resorbing bone (eat)
  3. osteoblasts - forming bone
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83
Q

what do osteoclasts produce? (2)

A
  • hydrogen ions
  • collagenase
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84
Q

what do osteoblasts secrete?

A

osteoids

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85
Q

what are the two modes of ossification?

A
  • intramembranous
  • endochondral
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86
Q

what is intramembranous ossification?

A

bone formed directly from osteoblasts with no template

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87
Q

what is endochondral ossification?

A

cartilage template formed which is then replaced by bone

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88
Q

what is an epiphyseal growth plate?

A

site of endochondral ossification

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89
Q

what are the zones of endochondral ossification? (5)

A
  • resting zone
  • zone of proliferation
  • zone of hypertrophy
  • zone of calcified cartilage
  • zone of resorption
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90
Q

what are the four steps of remodelling at the surface?

A
  • resorption
  • reversal
  • formation
  • resting
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91
Q

what happens in the remodelling deep in the bone? (2)

A
  • coupled action of osteoblasts and osteoclasts
  • leads to osteon formation
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92
Q

what are the reasons bone remodels? (7)

A
  • growth
  • mechanical requirements
  • fracture repair
  • maintenance
  • calcium store
  • age
  • pathology
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93
Q

what % of trabecular bone reforms each year?

A

25%

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94
Q

what % of cortical bone reforms each year?

A

2-3%

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95
Q

what is the lifespan of an osteon?

A

15 years

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96
Q

what are the stages of fracture repair? (4)

A
  1. hematoma formation
  2. fibrocartilaginous formation
  3. bony callus formation
  4. bone remodelling
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97
Q

what is Wolff’s Law?

A
  • low stimulus/activity = higher bone resorption
  • normal stimulus/activity = equal formation + resorption
  • high activity/stimulus = higher bone growth
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98
Q

how much microstrain can a cortical bone yield?

A

6,800 microstrain

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99
Q

what are the components of bone? (2)

A
  • collagen matrix
  • organic cells
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100
Q

what are the main functions of bone? (3)

A
  • mechanical support
  • blood cell production
  • calcium storage
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101
Q

what is bone a major site of?

A

mineral storage

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102
Q

what factors influence bone remodelling? (3)

A
  • exercise
  • age
  • medications
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103
Q

what age does bone mass increase rapidly?

A

0-30 years

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104
Q

how does bone mass increase rapidly? (2)

A
  • intertrabecular spaces fill in
  • bone cortical thickens
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105
Q

what happens to bone over the age of 30? (3)

A
  • gradual loss of bone marrow
  • trabecular thinning
  • increased bone porosity
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106
Q

what happens to bone during the menopause? (3)

A
  • decrease in oestrogen
  • decrease in osteoblast activity
  • osteoclast activity increases
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107
Q

what is calcium and phosphate storage regulated by? (2)

A
  • parathyroid hormone (PTH)
  • vitamin D
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108
Q

what are calcium and phosphate serum levels regulated by? (2)

A
  • excretion or resorption by kidneys
  • resorption and deposition of bone by osteoclasts and osteoblasts
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109
Q

how does the parathyroid hormone act on? (3)

A
  • releases calcium - bones
  • reduces calcium clearance - kidney
  • activates vitamin D to absorb calcium - intestines
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110
Q

what are the functions of calcium? (2)

A
  • muscle contraction
  • nerve conduction
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111
Q

what is calcium stored in the bone as?

A

hydroxyapatite

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112
Q

what does vitamin D promote?

A

absorption in the gut

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113
Q

what does the parathyroid hormone promote?

A

resorption by kidneys

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114
Q

what are the functions of phosphate? (2)

A
  • ATP
  • nucleic acids
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115
Q

what is phosphorous stored within the bone as?

A

hydroxyapatite crystals

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116
Q

what are the sources of vitamin D? (2)

A
  • diet
  • sunlight
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117
Q

what does the liver hydroxylate?

A

1, 25-hydroxyvitamin to 1,25 hydroxyvitamin D

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118
Q

what are the actions of 1, 25-hydroxyvitamin D? (3)

A
  • increase serum calcium phosphate
  • increase intestinal calcium and phosphate absorption
  • stimulates bone resorption
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119
Q

what doe the parathyroid hormone stimulate in bone? (2)

A
  • increase in osteolysis
  • increase in resorption
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120
Q

what doe the parathyroid hormone stimulate in the kidney? (2)

A
  • decreases renal calcium excretion
  • increases renal production of 1, 25 (OH)2 D3
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121
Q

what doe the parathyroid hormone stimulate in the intestine?

A
  • increased calcium and phosphate absorption
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122
Q

what is the opposition to the parathyroid hormone?

A

calcitonin

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123
Q

what is the role of calcitonin?

A

decrease blood calcium and phosphate

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124
Q

how does calcitonin reduce bone resorption?

A

activating calcitonin receptors expressed by osteoclasts

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125
Q

what maintains calcium homeostasis? (2)

A
  • parathyroid hormone
  • calcitonin
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126
Q

what is the role of oestrogen in bones?

A

maintaining bone mass

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127
Q

how does oestrogen reduce bone resorption?

A

inhibiting osteoblasts and osteoclasts

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128
Q

what does oestrogen lower?

A

serum calcium and phosphate

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129
Q

how do androgens decrease bone resorption?

A

by directly targeting osteoclasts

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130
Q

what are the symptoms of osteoporosis? (5)

A
  • height loss
  • back pain
  • stooped posture
  • bone fractures
  • bone/joint pain
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131
Q

what DEXA score defines osteoporosis?

A

T < -2.5

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132
Q

who are most affected by osteoporosis?

A

postmenopausal women

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133
Q

what is the role of vitamin D? (2)

A
  • calcium and phosphate homeostasis
  • bone mineralisation
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134
Q

what is osteomalacia? (2)

A
  • failure of bone mineralisation
  • caused by adult vitamin D deficiency
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135
Q

what are the causes or osteomalacia? (4)

A
  • diet
  • lack of sunlight
  • malabsorption
  • liver/kidney disease
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136
Q

how can osteomalacia be prevented? (3)

A
  • dietary supplements
  • sunlight exposure
  • education
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137
Q

how can osteomalacia be diagnosed?

A

blood test by clinical suspicion

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138
Q

how is osteomalacia treated?

A

Vitamin D supplements

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139
Q

what is the nervous system?

A

a complex network of nerve cells that regulate responses to internal and external stimuli

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140
Q

how can the nervous system be divided up? (2)

A

CNS - brain and spinal cord
PNS - everything

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141
Q

What type of control is involved in the PNS?

A

voluntary control

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142
Q

what is another name for the voluntary control of the PNS?

A

somatic nervous system

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143
Q

what is another name for the involuntary control of the CNS and PNS ?

A

visceral nervous system

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144
Q

What type of control is involved in the visceral nervous system?

A

involuntary control

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145
Q

What type of control is involved in the somatic nervous system?

A

voluntary control

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146
Q

what is the function of the nervous system?

A

to bring info from internal/external stimuli to the CNS

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147
Q

what are somatic nerves called?

A

afferent nerves

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148
Q

what are the two types of sensory nerves?

A
  • somatic afferent - carry info from external stimuli
  • visceral afferent - carry info from internal stimuli
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149
Q

what are motor nerves called?

A

efferent nerves

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150
Q

what are the two types of motor nerves?

A
  • somatic efferent - voluntary response (skeletal muscle)
  • visceral efferent - involuntary response (smooth & cardiac muscle)
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151
Q

what are the types of neuron? (4)

A
  • bipolar
  • unipolar
  • pseudounipolar
  • multipolar
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152
Q

what type of neurone is a multipolar neurone found in?

A

motor neurone

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153
Q

what two types of neurones are in sensory nerves?

A
  • bipolar
  • pseudounipolar
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154
Q

where are cell bodies found in the CNS?

A

collections with grey matter

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155
Q

where are cell bodies found in the PNS?

A

collections within ganglia e.g. dorsal root

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156
Q

where are axons found within the CNS?

A

tracts within white matter

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157
Q

where are axons found within the PNS?

A

bundle together to form nerves

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158
Q

where is grey matter located in both the spinal cord and brain?

A
  • spinal cord - inside
  • brain - outside
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159
Q

why is white matter dark on a spinal micrograph? (2)

A
  • stained for myelin
  • making the white matter appear dark
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160
Q

what does the central sulcus divide?

A

front and parietal lobes

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161
Q

what is the function of pre-central groups?

A

motor cortex

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162
Q

what is the function of the post-central gyrus?

A

sensory cortex

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163
Q

where is sensory information sent to and from?

A

thalamus (relay centre)

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164
Q

how does the thalamus decide where to send info to?

A

somatotropin map on the gyrus

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165
Q

what structures are inside the diencephalon? (2)

A
  • thalamus
  • hypothalamus
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166
Q

what is rostral and caudal?

A
  • rostral - front of brain
  • caudal - back of brain
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167
Q

what is the spinal nerve pathway?

A

rootlets, root, spinal nerve, rami

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168
Q

what is a plexus?

A

where the spinal nerve comes together to form peripheral nerve

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169
Q

what is the role of a plexus?

A

most efficient way of distributing axons around the body

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170
Q

what are the spinal nerve roots of the radial nerve?

A

C5-T1

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171
Q

what is a dermatome?

A

an area of skin supplied by one spinal segment

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172
Q

what is a myotome?

A

an area of muscle supplied by one spinal segment

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173
Q

what is a lesion?

A

a region in an organ or tissue which has suffered damage through injury or disease

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174
Q

how do we localise the type of lesion? (3)

A
  • focal
  • multifocal
  • systemic
    PNS to CNS
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175
Q

what is an example of a focal lesion? (3)

A
  • patient presents with pain and numbness in thumb, digits 2, 3 and 1/2 of 4
  • medial nerve C5-T1 affected
  • carpal tunnel syndrome
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176
Q

what is an example of a multifocal lesion? (3)

A
  • glial scars on white matter of brain and spinal cord
  • myelin surrounding axon becomes damaged
  • e.g. multiple sclerosis
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177
Q

what is an example of a systemic lesion?

A
  • loss of sensation in right, upper limb, trunk and lower limb
  • problems with speech, vision and hearing
  • e.g. brain tumour
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178
Q

what % of our body weight is skeletal muscle?

A

40%

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179
Q

what is skeletal muscle innervated by?

A

somatic motor neurons

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180
Q

what are the functions of skeletal muscle? (3)

A
  • force
  • movement
  • heat
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181
Q

what are satellite cells?

A

stem cells of the skeletal muscle

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182
Q

what is the main component of thick filament?

A

myosin 2

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183
Q

what is the main component of thin filament?

A

actin

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184
Q

what happens to the cross bridges in resting state?

A

tropomyosin blocks myosin binding site from binding to the myosin head

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185
Q

what happens to the cross bridges when muscle contracts? (4)

A
  • increase in calcium levels
  • binds to troponin C
  • changes conformation which pushes away from myosin binding site
  • myosin binding site is free to bind
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186
Q

what happens in the contraction cycle? (5)

A
  1. ATP binds to myosin head causing dissociation of the actin-myosin complex
  2. ATP is hydrolysed causing myosin heads to return to resting conformation
  3. cross bridge forms, myosin head binds to a new position on the actin
  4. Phosphate is released. Myosin head changes conformation. Filaments slide past each other
  5. ADP is released
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187
Q

what is rigor mortis?

A

state of muscular rigidity

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188
Q

when does rigor mortis begin?

A

3-4 hours after death

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189
Q

what causes rigor mortis? (2)

A
  • after death, Ca2+ ions diffuse out of the SR and allow myosin heads to bind to actin
  • cross-bridges cannot detach from active site, so muscles become locked
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190
Q

what are the stages in the contraction cycle?

A
  1. lag phase
  2. contraction phase
  3. relaxation phase
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191
Q

what happens in the lag phase?

A

Ca2+ release and binding to troponin

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192
Q

what happens in the contraction phase?

A

sarcomere cross bridge interactions increase

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193
Q

what happens in the relaxation phase?

A

elastic elements return sarcomere to resting length

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194
Q

how many types of muscle fibres are there?

A

3

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195
Q

what are the three types of muscle fibres?

A
  • type 1a - slow twitch - oxidative
  • type 2a - fast twitch - oxidative-glycolytic
  • type 2b - fast twitch - glycolytic
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196
Q

what is a motor unit?

A

a motor neurone innervating one set of muscle fibres

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197
Q

what are the advantages of the lever/fulcrum system? (2)

A
  • muscle operates at optimum length-tension relationship
  • maximises distance + speed which the load is moved
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198
Q

what are the disadvantages of the lever/fulcrum system?

A

requires more force to move or resist a load

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199
Q

how doe the neural tube form?

A

fusion of the two neural plates

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200
Q

what does the neuroectoderm differentiate into?

A
  1. neural plate
  2. neural crest cells
  3. ectodermal placodes
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201
Q

what forms the CNS?

A

neural plate

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202
Q

what does the neural tube become?

A

central part of the intervertebral column

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203
Q

what happens in neurulation?

A

formation and closing of the neural tube

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204
Q

what day does the rostral neuropore close?

A

25th day

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205
Q

what day does the caudal neuropore close?

A

27th day

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206
Q

what does the rostral neuropore become? (2)

A
  • lamina terminalis
  • anterior wall of the 3rd ventricle of the brain
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207
Q

what does the rostral neural tube become?

A

adult brain

208
Q

what does the caudal neural tube become?

A

adult spinal cord

209
Q

what does the neural lumen become? (2)

A
  • ventricular system
  • central canal
210
Q

what is an example of an upper neural tube defect?

A

anencephaly

211
Q

what is an example of an lower neural tube defect?

A

spina bifida occulta

212
Q

what does the prosencephalon develop into? (2)

A
  • telencephalon
  • diencephalon
213
Q

what does the mesencephalon develop into?

A

stays as the mesencephalon

214
Q

what does the rhombencephalon develop into? (2)

A
  • metencephalon
  • myelencephalon
215
Q

what does the telencephalon give rise to?

A

cerebral hemispheres

216
Q

what does the diencephalon give rise to?

A

thalami

217
Q

what does the mesencephalon give rise to?

A

midbrain

218
Q

what does the metencephalon give rise to? (2

A
  • pons
  • cerebellum
219
Q

what does the myelencephalon give rise to?

A

medulla

220
Q

what are the flexures in brain development? (3)

A
  • pontine flexure
  • mesencephalic flexure
  • cervical flexure
221
Q

what is a distinguishing feature of brain development at 21 weeks?

A

outline of cerebral hemispheres

222
Q

what are the three zones of the neural tube?

A
  1. matrix zone
  2. mantle zone
  3. marginal zone
223
Q

what makes up the matrix zone?

A

pluripotent neuroepithelial cells

224
Q

what makes up the mantle zone?

A

future grey matter

225
Q

what makes up the marginal zone?

A

future white matter

226
Q

what day does the sulcus limitans form?

A

day 4/40

227
Q

what is the function of the sulcus limitans?

A

separates alar and basal plates

228
Q

where does the sulcus limitans extend to?

A

extends from spinal cord to rostral midbrain

229
Q

what is the function of the alar plate?

A

relieves axons from dorsal root ganglion

230
Q

what does the alar plate become?

A

dorsal horn (sensory)

231
Q

what does the basal plate become?

A

ventral horn (motor)

232
Q

what is the order of the nerves running down the spinal cord (dorsal to ventral)? (4)

A
  • somatic afferent
  • visceral afferent
  • visceral efferent
  • somatic efferent
233
Q

what are the special sensory cranial nerves? (3)

A

-olfactory (CN I)
- optic (CN II)
- vestibuolocochleaer (CNV III)

234
Q

what are the somatic efferent cranial nerves? (4)

A
  • trochlear (CNIV)
  • hypoglossal (CN XII)
  • abducens (Cn VI)
  • oculomotor (CN III)
235
Q

what nerve innovates the 1st pharyngeal arch?

A

trigeminal (CN V)

236
Q

what nerve innovates the 2nd pharyngeal arch?

A

facial (CN VII)

237
Q

what nerve innovates the 3rd pharyngeal arch?

A

glossopharyngeal (CN IX)

238
Q

what nerve innovates the 4th and 6th pharyngeal arch?

A

vagus (CN X)

239
Q

which nerve arises from the spinal cord and enters the cranium?

A
  • spinal accessory nerve (CN XI)
  • through C1 to C5
240
Q

what is the definition of pain?

A

unpleasant sensory and emotional experience associated with actual or potential tissue damage (subjective)

241
Q

what is the definition of nociception?

A

neural processes of detecting, encoding and processing noxious stimuli (physiological)

242
Q

why do we need pain? (4)

A
  • protective
  • avoid harmful stimulations
  • rest injured part of body
  • protect during sleep
243
Q

why is pain bad? (2)

A
  • persists even when tissues have healed
  • no useful function in some instances e.g chronic pain
244
Q

how do we characterise pain? (2)

A
  • origin
  • duration
245
Q

what can pain be divided into by origin? (2)

A
  • somatic
  • visceral
246
Q

what can somatic pain be divided into? (2)

A
  • superficial
  • deep
247
Q

how do you characterise superficial pain? (2)

A
  • sharp
  • brief
  • e.g. pinprick, cut
248
Q

how do you characterise deep pain?

A
  • longer than superficial
  • e.g. muscle cramps
249
Q

how do you characterise visceral pain?

A
  • dull ache
  • e.g. appendicitis
250
Q

what can pain be divided by its duration?

A
  • acute
  • chronic
251
Q

what is acute pain? (2)

A
  • pain that resolves when injury heals
  • ends in days/weeks
252
Q

what is chronic pain? (2)

A
  • pain that persists
  • > 3 months
253
Q

what are nociceptors?

A

sensors found in most body tissues that respond to noxious stimuli

254
Q

what do nociceptors contain?

A

free-nerve endings

255
Q

what are the types of nociceptors? (5)

A
  • thermal - extreme temperature
  • mechanical - excess pressure
  • chemical - chemical stimulants
  • polymodal - all of the above
  • sleeping/silent - inflammation
256
Q

what are nociceptors characterised by? (2)

A
  • axon properties
  • receptor channels
257
Q

what pain fibre is the most common?

A

C fibres

258
Q

what are large diameter fibres? (2)

A
  • Aa
  • Ab
259
Q

what are characteristics of Aa and Ab fibres? (4)

A
  • large diameter
  • rapidly conducting
  • low threshold
  • touch (somatosensory)
260
Q

what are characteristics of A delta and C fibres? (3)

A
  • small diameter
  • slow conducting
  • associated with nociceptors and thermoreceptors
261
Q

what is 1st pain?

A

fast pain

262
Q

what are the characteristics of 1st pain? (6)

A
  • A delta fibre
  • mechanical/thermal receptors
  • sharp or prickling
  • easily located
  • occurs rapidly
  • short duration
263
Q

what are the characteristics of 2nd pain? (5)

A
  • slow
  • C fibres
  • poorly localised
    easily located
  • polymodal receptors
264
Q

what is the transaction of pain? (5)

A
  1. receptors activated by noxious stimuli
  2. receptor potential depolarises membrane, opens up Na+ channel actives an AP
  3. AP enters spinal cord via dorsal horn
  4. voltage gated Ca2++ channels release neurotransmitters, activates 2nd order nuerones in SC and sends signal to the brain
265
Q

what causes congenital analgesia?

A

mutations in the genes controlling Na+ channels

266
Q

what is congenital analgesia? (2)

A
  • inability to feel pain externally and internally
  • e.g. recurrent braises, joint deformities, reduced life expectancy
267
Q

what spinal pathway conducts pain?

A

spinothalamic

268
Q

how does the spinothalamic pathway conduct pain?

A
  1. C and A delta fibres enters dorsal horn synapsing with 2nd order neuron
  2. contralaterally travels up SC
  3. info is relayed via the medulla to the thalamus
  4. pain is relayed to the somatosensory cortex
269
Q

where does the 2nd order neurone decussate in the spinothalamic tract?

A

spinal cord

270
Q

which spinal pathway conducts touch, vibration and proprioception?

A

dorsal column-medial lemniscal

271
Q

what does the dorsal column-medial lemniscal pathway conduct? (3)

A
  • touch
  • vibration
  • proprioception
272
Q

where does the 2nd order neurone decussate in the dorsal column pathway?

A

medial lemniscus of the medulla oblongata

273
Q

what is the result of a unilateral injury in the dorsal column pathway? (2)

A
  • loss on the SAME side of the spinal cord
  • decrease in touch, pressure and proprioception
274
Q

what is the result of a unilateral injury in the spinothalamic pathway? (2)

A
  • loss on the OPPOSITE side
  • decrease in pain
275
Q

what is referred pain caused by?

A

convergence of nociceptor inputs from viscera and skin

276
Q

how is referred pain produced? (2)

A
  • afferents from organs and skin enter the spinal cord through the same route and target overlapping of spinal neurone
  • e.g. angina
277
Q

what is phantom limb pain?

A

sensation that a missing limb is still attached to the body

278
Q

what % of amputees experience phantom limb pain?

A

60%-80%

279
Q

what are some treatments for phantom limb pain? (3)

A
  • painkillers
  • mirror therapy
  • stump stimulation
280
Q

what is gate theory? (2)

A
  • local interneurons act as a gate
  • co-activation of A alpha/ A delta and C fibres
281
Q

what does gate theory explain? (2)

A
  • why pain is reduced by stimulating mechanoreceptors
  • e.g. rubbing knee after falling over
282
Q

what is hyperalgesia?

A

increased sensitivity to pain from a stimulus normally making pain

283
Q

what is allodynia?

A
  • pain from a stimulus that does NOT normally provoke pain?
  • e.g. light touch
284
Q

where does primary and secondary hyperalgesia occur?

A
  • primary - in site of tissue damage
  • secondary - around site of tissue damage
285
Q

what is fibromyalgia?

A

type of allodyna

286
Q

what % of the population suffer with fibromyalgia?

A

2%-4%, 90% females

287
Q

how is fibromyalgia diagnosed?

A

identifying key tender parts of body

288
Q

how is fibromyalgia treated?

A
  • analgesics
  • antidepressants
  • counselling
289
Q

what is the main cause of disability in Britain?

A

back pain

290
Q

how much does back pain cost society in sicknesses/absences per year?

A

£7.2 billion

291
Q

what are the ways to treat pain? (4)

A
  • stimulation
  • pharmacological
  • psychological
    -neurosurgery
292
Q

what is an opioid?

A

any substance that produces morphine like effects

293
Q

what are the types of opioid receptors? (3)

A
  • Mu
  • Delta
  • Kappa
294
Q

where do endogenous analgesic pathways arise from? (2)

A
  • periaqueductal grey matter
  • raphe nuclei
295
Q

what does opioids block?

A

substance P release

296
Q

name 3 common clinical opioid analgesics?

A
  • morphine
  • herion
  • codeine
297
Q

what is an action potential?

A

rapid change in electrical potential across the plasma membrane of the cell

298
Q

what is used to reverse opioids?

A
  • naloxone
  • blocks opioid receptors
299
Q

where do action potentials occur? (3)

A
  • neurons
  • muscle fibres
  • endocrine cells
300
Q

why do action potentials occur?

A

intra/inter cellular communication

301
Q

how does an AP occur? (5)

A
  1. signals arrive via synaptic transmission from presynaptic neurons
  2. electrotonic potential spread passively from dendrites to soma
  3. negative and positive electronic potentials are integrated in the soma
  4. sum of electrotonic potentials reaches axon hillock
  5. if net electric potential is greater than the threshold at the axon hillock an AP is produced
302
Q

what is membrane potential?

A

difference in electric potential between the interior and exterior of a cell

303
Q

what is baseline resting potential?

A

-70mV

304
Q

what does resting potential mean?

A

inside of neurone is negatively charged relative to outside

305
Q

how is resting potential established?

A

electrochemical gradient across a cell membrane

306
Q

what are the main ions involved in an AP? (2)

A
  • Na+
  • K+
307
Q

what are ion channels made of?

A

proteins found in the plasma membrane

308
Q

what do ion channels allow? (2)

A
  • transfer of ions across cell membrane
  • selective for specific ions
309
Q

what are voltage-gated channels?

A

channels that open and close in response to voltage change e.g. Na+

310
Q

what are ligand-gated channels?

A

channels that open and close in response to a chemical or drug

311
Q

what does an Na+/K+ pump do? (2)

A
  • allows ions to travel across membrane against their concentration gradient
  • pumps 3 Na+ out for every 2K+ in
312
Q

what sets up the resting potential? (3)

A
  • low protein permeability
  • Na+/K+ pump
  • high K+ permeability
313
Q

what is equilibrium potential?

A

voltage at which ions net flow across membrane is 0

314
Q

what is a Thanatron?

A

‘death machine’ used to assist in suicide

315
Q

How did the Thanatron work? (3)

A
  • injected saline
  • injected anaesthetic (make patient unconscious)
  • infused potassium chloride (kill)
316
Q

how does infusion of potassium chloride kill? (2)

A
  • elevated K+ levels caused resting potential to be less negative (depolarisation)
  • interferes with cardiac muscle contraction, stops heart
317
Q

what are the stages of initiating an action potential?

A
  1. resting state
  2. depolarising phase
  3. repolarising phase
  4. undershoot
318
Q

what occurs at the resting stage? (2)

A
  • -70mV
  • all voltage gated Na+ and K+ channels close
319
Q

what occurs at the depolarising phase? (2)

A
  • -55mV
  • voltage sensitive gates of Na+ channels open
320
Q

what occurs at the depolarising phase? (2)

A
  • +40mV
  • K+ channels open, Na+ channels close
321
Q

what occurs at the undershoot phase? (2)

A
  • -80mV
  • K+ stay open, Na+ gates close
322
Q

what are the two thresholds?

A
  • sub threshold - < -55mV
  • supra threshold - > -55mV
323
Q

how is an AP conduced in an UNmyelinated axon? (4)

A
  1. Na+ entry at axon hillock depolarises axon
  2. Depolarises adjacent reigon of axon, opening more Na+ channels
  3. Previous Na+ channels inactivated, current flows one way
  4. Results in propagation down the axon
324
Q

how is an AP conducted in a myelinated axon? (4)

A
  1. Na+ entry at axon hillock depolarises axon
  2. myelin sheath insulates axon, prevents ion leakage
  3. Na+ and K+ concentrated only at the Nodes of Ranvier
  4. AP ‘jumps’ from one node to the next - saltatory conduction
325
Q

what does axon conduction depend on? (2)

A
  • axon diameter
  • myelination
326
Q

what are unmyelinated axons better for?

A

small diameter axons

327
Q

what are myelinated axons better for?

A

large diameter axons

328
Q

what are some clinical uses of EEGs? (5)

A
  • epilepsy
  • sleep disorders
  • hearing & vision
  • brain surgery
  • brain death
329
Q

what is an example of a demyelination disorder?

A
  • multiple sclerosis
  • T cells attack myelin sheath
330
Q

Where does the spinal cord run to and from?

A

foramen magnum to L1/L2

331
Q

what are the three layers of the meninges?

A
  1. dura matter
  2. arachoid matter
  3. pia mater
332
Q

where do you find CSF?

A

subarachnoid matter

333
Q

where is the subarachnoid matter?

A

between the arachnid and Pia mater

334
Q

what are the two fasiculi the dorsal column pathway travel through?

A
  • gracile
  • cunneate
335
Q

what are funiculi?

A

bundle of tracts (axons) within white matter of spinal cord

336
Q

what is meant by ipsilateral?

A

occurring on the same side of the body

337
Q

what is meant by contralateral?

A

occurring on the opposite side of the body

338
Q

what is the brainstem divided into? (3)

A
  • midbrain
  • pons
  • medulla
339
Q

what makes up the tectum? (2)

A
  • superior colliculus
  • inferior colliculus
340
Q

what is the space between the brainstem and cerebellum called?

A

4th ventricle

341
Q

which cervical nerves originate from the midbrain? (2)

A

3 and 4

342
Q

which cervical nerves originate from the pons?

A

5, 6, 7, 8

343
Q

which cervical nerves originate from the medulla?

A

9, 10, 11, 12

344
Q

what is the function of the brainstem? (2)

A
  • controls the flow of messages between the brain and rest of the body
  • controls basic bodily functions e.g. breathing, HR and BP
345
Q

what is brainstem death? (2)

A
  • patient is unconscious
  • cannot breathe, cough, swallow, no pupillary reflex or gag
346
Q

what tracts control conscious sensation? (2)

A
  • dorsal column
  • spinothalamic
347
Q

what tracts control unconscious sensation? (4)

A
  • spinocerebellar
  • spinoreticular
  • spino-olivary
  • spinotectal
348
Q

which fasiculus controls signals above T6?

A

cuneate

349
Q

which fasiculus controls signals below T6?

A

gracile

350
Q

how many neurons are involved in the motor pathways? (2)

A

2 neurons

351
Q

Where are upper motor neurons located?

A

within the CNS

352
Q

where are lower motor neurons located?

A

within the PNS

353
Q

where do UMNs originate from?

A

cerebral cortex

354
Q

where do LMNs project to?

A

muscles

355
Q

where do UMNs project to?

A

LMN in brainstem

356
Q

how can you divide the descending tracts? (2)

A
  • dorsolateral
  • ventromedial
357
Q

what are the functions of the dorsolateral tract? (2)

A
  • supplies distal muscles
  • controls fine movement
358
Q

what are the functions of the ventromedial tract? (2)

A
  • supplies proximal limbs
  • posture and movement correction
359
Q

what tracts make up the dorsolateral pathways? (2)

A
  • lateral corticospinal
  • rubrospinal
360
Q

what is the mechanism of the reticulospinal tract? (3)

A
  • 1 neuron - arise from pons + medullary formation
  • remain ipsilateral
  • 2nd neuron - synapse with LMN in medial aspect of ventral horn
361
Q

what are the functions of the reticulospinal tract? (2)

A
  • posture and gait related movements
  • modulates sensation
362
Q

what is the mechanism of the tectospinal tract? (3)

A
  • 1st neuron - arise from superior colliculi
  • Decussates in midbrain
  • 2nd neuron - synapse with LMN in cervical spinal cord
363
Q

what are the functions of the tectospinal tract? (2)

A
  • head turning in response to visual stimuli
  • co-ordination of head and eye movement
364
Q

what is the mechanism of the vestibular tract? (3)

A
  • 1st neuron - arise from vestibular nuclei
  • remains ipsilateral
  • 2nd neuron - synapse with LMN in medial aspect of dorsal horn
365
Q

what are the functions of the vestibular tract? (2)

A
  • positioning of head and neck
  • balance - in response to sudden change
366
Q

what happens when there is a unilateral lesion of the vestibular tract?

A

no obvious defects

367
Q

what happens when there is a unilateral lesion of the bilateral tract? (2)

A
  • loss of control
  • trunk mobility
368
Q

what tracts make up the dorsolateral pathways? (2)

A
  • lateral corticospinal
  • rubrospinal
369
Q

what tracts make up the ventromedial pathways? (4)

A
  • anterior corticospinal
  • reticulospinal
  • tectospinal
  • vestibulospinal
370
Q

what is the mechanism of the rubrospinal tract? (3)

A
  • 1st neuron - originates in the red nucleus of the brain
  • decussates in the midbrain
  • contralateral supply to head, neck and upper limbs
371
Q

what are the functions of the rubrospinal tract? (2)

A
  • control of muscle tone in flexor group
  • co-ordination of movement
372
Q

what is the mechanism of the corticospinal tract? (4)

A
  • 1st neuron - arise from primary motor cortex, pre-motor and sensory cortex
  • pass through internal capsule
  • pass through peduncles in midbrain
  • synapse with LMN in the ventral horn
373
Q

what % of tracts decussate below pyramids in the corticospinal tract?

A

75%-90%

374
Q

what are the functions of the corticospinal tract? (3)

A
  • voluntary motor control of skeletal muscle
  • fine movement
  • sensory modulation
375
Q

how do you test the corticospinal tract in babies?

A
  • running up an object laterally up foot
  • toes curl when tract fully developed
376
Q

what is a +ve Babinski sign?

A

toes extend rather than curl

377
Q

what does a +ve Babinski sign show? (2)

A
  • corticospinal tract is not yet developed
  • should be the case for babies <2 years old
378
Q

what is the result of a lesion above decussation in the corticospinal tract? (2)

A
  • contralateral spastic paresis
  • +ve Babinski sign
379
Q

what is the result of a lesion below decussation in the corticospinal tract? (2)

A
  • ipsilateral spastic paresis
  • +ve Babinski sign
380
Q

what are the symptoms of a corticospinal tract lesion? (3)

A
  • loss of independent finger flexion
  • loss of speed and agility
  • clumsiness and weakness
381
Q

where do sensory neurons enter the spinal cord?

A

dorsal horn

382
Q

where do sensory neurons exit the spinal cord?

A

ventral horn

383
Q

where are the two spinal enlargements?

A
  • cervical - C3-T1
  • lumbar - L1-S3
384
Q

where are the axial muscles located? (2)

A
  • trunk
  • head (posture)
385
Q

where are the proximal muscles located? (2)

A
  • upper limbs (locomotion)
386
Q

where are the distal muscles located? (2)

A
  • hands
  • feet (object manipulation)
387
Q

what is responsible for sending signals for muscles to contract?

A

alpha motor neuron/final common pathway

388
Q

what are lower motor neurons? (3)

A
  • neurons in the brainstem and SC
  • axons leave the CNS
  • synapse on muscle fibres
389
Q

what are upper motor neurones? (3)

A
  • neurons in cerebral cortex and brainstem
  • axons remain in the CNS
  • synapse on LMN directly
390
Q

what does the motor neurone release?

A

acetylcholine at the axon terminal

391
Q

what is the role of Ach released by motor neurones?

A

contracts muscle fibres

392
Q

what do spinal motor neurones receive input from? (5)

A
  • muscle spindles
  • golgi tendon organs
  • cutaneous receptors
    -spinal interneurons
  • UMN
393
Q

what is the most common neurone disease in adult

A

motor neurone disease

394
Q

what is motor neurone disease?

A

degeneration of motor neurones

395
Q

what are the symptoms of motor neurone disease? (3)

A
  • muscle weakness
  • atrophy
  • twitching
396
Q

what is the treatment for motor neurone disease?

A

Riluzole - blocks glutamatergic neurotransmission

397
Q

what is a reflex?

A

involuntary movement that occurs as a result of sensory stimulation

398
Q

what is a reflex arc?

A

composed of a sensory neurone, interneurone and a motor neurone

399
Q

what is the function of a reflex arc? (2)

A
  1. protects body against damage
  2. co-ordinate muscle activity
400
Q

what is the stretch reflex also known as?

A

myotatic reflex

401
Q

what happens at a stretch reflex? (2)

A

single synapses between muscle sensory fibre and an alpha motor neuron
- monosynaptic

402
Q

what does a muscle spindle consist of? (3)

A
  • intrafusal musle fibres
  • Ia sensory fibres
  • y motor neurones
403
Q

what happens when you stretch a muscle spindle?

A

increases Ia afferent activity

404
Q

what are muscle spindles important for?

A

proprioception

405
Q

what are the function of gamma motor neurones?

A

fine tuning the muscle spindle back to original position

406
Q

what is reciprocal inhibition? (2)

A
  1. monosynaptic stretch reflex contracts agonist muscle
  2. reciprocal inhibition of the antagonist muscle
407
Q

what does reciprocal inhibition allow?

A

contraction of the muscle to not be unopposed

408
Q

what is the inverse stretch reflex?

A

a protective reflex to prevent muscles and tendons from being damaged

409
Q

where is a Golgi tendon organ located?

A

junction of muscle tendon

410
Q

what is a Golgi tendon organ innervated by?

A

Ib afferent

411
Q

what is the function of a Golgi tendon organ?

A
  • encodes and regulates muscle tension
  • protects muscles and tendons from damage
412
Q

what do Golgi tendon organs prevent?

A

muscle overload

413
Q

how does the inverse stretch reflex work? (2)

A
  1. Ib afferents from Golgi tendon organ synapse with inhibitory neurones in the spinal cord
  2. activation of Ib afferents decreases activity of motor neurones
414
Q

how does the inverse stretch reflex protect against overload?

A

when tension is too much, contraction ceases and muscle relaxes

415
Q

what is the mechanism of the flexor withdrawal reflex? (4)

A
  1. stimulation of nociceptors
  2. signal travels through afferent neurones to interneurons in the spinal cord
  3. interneurons synapse with alpha motor neurones
  4. neurone flexes
416
Q

what produces rhythmic movement? e.g walking

A

central pattern generators (CPGs)

417
Q

what are central pattern generators?

A

neural networks that produce rhythmic feedback patterned outputs without sensor

418
Q

what do central pattern generators generate?

A

alternating flexion and extension (rhythm) of limbs during locomotion

419
Q

why are central pattern generators important?

A

automate control of rhythmic movements important for survival

420
Q

what is the function of the medial longitudinal fissure?

A

separates the right and left cerebrum

421
Q

name the poles in the brain? (3)

A
  • frontal pole
  • temporal pole
  • occipital pole
422
Q

what are the cerebral arteries involved in the circle of willis? (6)

A
  • middle cerebral
  • anterior cerebral
  • posterior cerebral
  • internal carotid
  • basilar artery
  • vetebral artery
423
Q

what branches do cerebral arteries give off? (2)

A
  • cortical
  • central/striate
424
Q

what are the cortical branches of cerebral arteries?

A

superficial branch

425
Q

what are the central branches of cerebral arteries?

A

deep - penetrate through the substance to supply structures deep inside cerebral hemisphere

426
Q

what is the main arterial supply of the lateral surface of the brain?

A

middle cerebral artery

427
Q

what is the main arterial supply of the medial surface?

A

anterior cerebral artery

428
Q

what is the main arterial supply of the inferior surface?

A

posterior cerebral artery

429
Q

what is the result of damage to the middle cerebral artery?

A

contralateral upper limb weakness

430
Q

what is the result of damage to the anterior cerebral artery?

A

contralateral lower limb weakness

431
Q

what is the result of damage to the posterior cerebral artery?

A

contralateral hemisensory loss

432
Q

what are the efferent neurons of the primary motor cortex? (2)

A
  • somatosensory area
  • pre-motor area
433
Q

where do impulses from the primary motor cortex travel to?

A

anterior horn of spinal cord

434
Q

what is the role of the cerebellum?

A

co-ordination of ongoing movement

435
Q

what is the role of the basal ganglia?

A

selection/initiation of voluntary movements

436
Q

what is the result of damage to the cerebellum? (3)

A
  • movements jerky
  • unco-ordinated
  • inaccurate (ataxia)
437
Q

what is the result of damage to the basal ganglia?

A

uncontrolled movements e.g. Parkinson’s

438
Q

what is the shared function of the cerebellum and basal ganglia? (2)

A
  • improve accuracy of movements
  • modify UMN signals only
439
Q

what % of neurons does the cerebellum contain?

A

50

440
Q

how does the cerebellum co-ordinate movement? (2)

A
  • detects differences in ‘motor error’
  • stores learnt movement e.g. conscious to unconscious
441
Q

what are the divisions of the cerebellum? (3)

A
  • cerebrocerebellum
  • spinocerebellum
  • vestibulocerebellum
442
Q

what is the input of the cerebrocerebellum?

A

cerebral cortex

443
Q

what is the input of the spinocerebellum?

A

direct input from spinal cord

444
Q

what is the input of the vestibulocerebellum?

A

input from vestibular nuclei in the brainstem

445
Q

what movement does the cerebrocerebellum control?

A

regulation of highly skilled movements

446
Q

what movement does the spinocerebellum control?

A

movements of proximal muscles

447
Q

what movement does the vestibulocerebellum control?

A

movements underlying posture

448
Q

what are the peduncles in the cerebellum? (3)

A
  • superior cerebral
  • middle cerebral
  • inferior cerebral
449
Q

what are the inputs into the cerebellum? (4)

A
  • frontal motor cortex to the red nuclei and pontine nucleus
  • potine nucleus crosses the midline to the cerebral cortex
  • red nuclei to the inferior olive. Inferior olive crosses midline to cerebral cortex
  • SC and vestibular nucleus enter the cerebral cortex on the same side
450
Q

what are the outputs from the cerebellum? (3)

A
  • cerebral cortex to deep cerebellar nuclei
  • crosses midline to ventral lateral complex (thalamus)
  • thalamus to primary motor cortex
451
Q

what are the three deep cerebellar nuclei? (3)

A
  • vestibular nuclei
  • interposed (Fastigial) nuclei
  • senate nucleus
452
Q

what division does the vestibular nucleus supply?

A

vestibulocerebellum

453
Q

what division does the interposed (Fastigial) nucleus supply?

A

spinocerebellum

454
Q

what division does the denate nucleus supply?

A

cerebrocerebellum

455
Q

what movement does the vestibular nuclei signal?

A
  • balance
  • eye movements
456
Q

what movement does the dentate nucleus signal?

A

motor planning

457
Q

what movement does the fastigial nuclei signal?

A

motor execution

458
Q

what are the main inputs of the cerebellar cortex? (2)

A
  • climbing fibres
  • mossy fibres
459
Q

what are the main outputs of the cerebellar cortex?

A

purkinje cells

460
Q

what are the types of interneurons? (2)

A
  • excitatory - granule
  • inhibitory - stellate, Golgi, basket cells
461
Q

what is the role of climbing factors?

A

carry error signals when movement has failed to meet expectations

462
Q

how does the cerebrum make corrections to movement?

A

alters the effectiveness of the parallel inputs to the Purkinje cell

463
Q

how do Purkinje cells transmit their signals?

A

synapse on neurons in the deep cerebral nuclei

464
Q

what neuotransmitter do Purkinje cells use?

A

GABA - inhibitory

465
Q

how many fibres does a Purkinje cell synapse with?

A

synapses once but on 100,000 parallel fibres

466
Q

what does cerebellar injury disrupt?

A

modulation and co-ordination of movements

467
Q

which side of the body are movement errors damage found?

A

same side as cerebellum

468
Q

which side of the body are sensory and motor damage found?

A

opposite side as cerebellum

469
Q

what is the result of damage to the vestibulocerebellum?

A

disturbances of balance and eye movement

470
Q

what is the result of damage to the spinocerebellum?

A

impaired gait
- wide with small shuffling movements

471
Q

what is the result of damage to the cerebrocerebellum?

A

impairments in highly skilled sequences of learned movements

472
Q

what is the cerebral damage from alcohol? (2)

A
  • degeneration of anterior cerebellum
  • affects movements of lower limbs
473
Q

what is the basal ganglia?

A

collection of functionally distinct nuclei

474
Q

what structures make up the basal ganglia? (5)

A
  • caudate nucleus
  • putamen
  • globus pallidus
  • substantia nigra
  • sub-thalamic nucleus
475
Q

what structures make up the striatum? (2)

A
  • caudate nucleus
  • putamen
476
Q

what makes up the output zone? (2)

A
  • globus pallidus
  • substantia nigra
477
Q

how does the basal ganglia modulate movement?

A

complex feedback circuitry

478
Q

what two pathways enter the striatum?

A
  • corticostriatal
  • nigrostriatal
479
Q

what is the input and neurotransmitter of the corticostriatal pathway? (2)

A
  • inputs from cerebral cortex
  • glutamate (excitatory)
480
Q

what is the input and neurotransmitter of the nigrostriatal pathway? (2)

A
  • inputs from substantia nigra
  • dopamine (modulatory)
481
Q

which pathway is modulated by D1 receptors?

A

Direct pathway

482
Q

which pathway is modulated by D2 receptors?

A

indirect pathway

483
Q

how does the substantia nigra increase movement? (2)

A
  • exciting the direct pathway
  • inhibiting the indirect pathway
484
Q

What is the mechanism of the direct pathway? (5)

A
  • Globus pallidus inhibits thalamus, reduces excitation of motor cortex
  • Cerebral cortex excites striatum
  • This inhibits the globus pallidus
  • Releases tonic inhibition of the thalamus
  • Thalamus excites motor cortex - initiating movement
485
Q

What is the mechanism of the indirect pathway? (4)

A
  • Command from cerebral cortex excites striatum
  • This inhibits the external globus pallidus
  • External then inhibits the internal segment
  • This increases tonic inhibition of the thalamus, reducing excitation and inhibiting movement
486
Q

What is a hypokinesia disorder?

A

Paucity of movement

487
Q

What is the cause of hypokinesia disorder?

A

Idiopathic, some genetic

488
Q

What are the clinical characteristics of hypokinesia disorder? (TRAP)

A
  • T - tremor
  • R - rigidity of muscles
  • A - akinesia
  • P - postural problems
489
Q

What is the neuropathology of Parkinson’s disease? (3)

A
  • Degeneration of neurons in substantia nigra
  • This decreases dopamine availability
  • Results in decreased activity of direct pathway, increases indirect activity
490
Q

What are some treatments of Parkinson’s disease? (5)

A
  • L-DOPA (levodopa)
  • Dopamine agonists
  • Foetal cell transplants
  • Deep brain stimulation
  • Dancing and music
491
Q

What is the cause of Huntington’s disease? (3)

A
  • Death of striatal inputs to globus pallidus external (indirect)
  • Reduces excitation internal segment, less tonic inhibition of thalamus
  • Greater excitation of motor cortex, increase of movement
492
Q

What is white matter in the cerebellum called?

A

Arbor vitae

493
Q

What is grey matter in the cerebellum called?

A

Gyri, foli

494
Q

What tracts make up the medial descending tracts? (2)

A
  • Media vestibulospinal
  • Medial reticulospinal
    (axial muscles)
495
Q

What tracts makes up lateral descending tracts? (2)

A
  • Lateral vestibulospinal
  • Lateral reticulospinal
    (proximal + distal muscles)
496
Q

What tracts make up cortical tracts? (2)

A
  • Lateral corticospinal
  • Lateral rubrospinal
    (fingers and toes)
497
Q

How many vestibular nuclei are there?

A

4

498
Q

what does grey matter signal?

A

Interpretation and generation

499
Q

What does white matter signal?

A

Transmission

500
Q

How do we know which region controls a particular function? (5)

A
  • Cytoarchitectural studies (Brodmann)
  • Post mortem studies
  • Intraoperative electrocortical stimulation
  • Medical imaging
  • Animal studies
501
Q

What is the precentral gyrus?

A

Primary motor cortex

502
Q

What is the post central gyrus?

A

Primary somatosensory cortex

503
Q

What is the result of a lesion to the primary sensory cortex?

A

Contralateral loss of touch, pressure and proprioception

504
Q

What is the result of a lesion to the secondary sensory cortex?

A

Loss of sensation of pain

505
Q

What is the result of a lesion of the dominant hemisphere?

A
  • Apraxia e.g. disorders of performing skilled movements
  • Language dysfunction
506
Q

Which hemisphere is the most dominant in the population?

A

Left

507
Q

Where is language comprehension found?

A

The dominant hemisphere

508
Q

What are left-handed individuals more likely to present with?

A

Bilateral representation of language

509
Q

What is the non-dominant hemisphere specialised for?

A

Non-verbal functions e.g. emotional significance to language

510
Q

What were the features of Pierre Broca’s patient (1861) (3)

A
  • Understood language but couldn’t speak
  • Could whistle and sing lyrics
  • Lesion in posteroinferior frontal lobe
511
Q

What were the features of Karl Wernicke’s patient (1876) (2)

A
  • Could speak but not understand language
  • Lesion at junction of temporal, parietal and occipital lobes
512
Q

What % of blood flow in the brain come from internal carotid?

A

60%-80%

513
Q

What are the functions of the pre-frontal cortex? (4)

A
  • Abstract thinking
  • Decision making/planning
  • Prioritising
  • Goal directing behaviour
514
Q

What is the result of a lesion of the pre-frontal cortex? (6)

A
  • Disinhibition
  • Changes in personality
  • Decrease in concentration, judgement, abstract thought and problem solving ability
515
Q

What is the result of disruption to anterior cerebral artery? (2)

A
  • Frontal lobe behavioural abnormalities
  • Lower limb weakness
516
Q

What is the result of disruption to middle cerebral artery? (3)

A
  • Upper limb weakness
  • Loss of language
  • Loose sense of self awareness
517
Q

What is the result of disruption to posterior cerebral artery?

A
  • Vision loss
  • Blindness over half the field of vision

ALS (10 decks)

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