Exam 3 Flashcards
What is the order of the unconscious relay tracts
1st order: from sensory receptors to dorsal horn
2nd order: from dorsal horn to ipsilateral cerebellum
sensory information goes to the cerebellum on the _____ side of the body
same (ipsilateral)
what are the 3 functions of sensation
- contribute to smooth, controlled movement
- protects from injury
- contributes to perception of the environment
2 problems patients can have with sensation
- sensory loss: nerves fail to transmit sensory messages
2. nerves transmit inappropriate messages
what are you testing when you test discriminative touch
A-beta
DC/ML pathway
what are you testing when you test conscious proprioception
Ia
Ib
II
DC/ML pathway
what are you testing when you test fast pain
A-delta
anterolateral column
what are you testing when you test discriminative temperature
A-delta
anterolateral column
what are you testing when you test “cortical” sensations
stereognosis
processing
what are the 3 components of a quick screening
vibration
conscious proprioception
fast pain
what is an important pathology that Femmes-Weinstein is used test
diabetic polyneuropathy
what are the components of a complete physical exam
discriminative touch cortical sensations conscious proprioception fast pain discriminative temperature
what is used to test tactile threshold
Femmes-Weinstein monofilament
what does the thinnest monofilament test
lowest threshold sensory receptors
what does two-point discrimination test
the brain’s ability to separate 2 receptive fields or cortical processing of sensation
what is the purpose of bilateral simultaneous touch
test brain’s ability to pay attention to bilateral inputs
things that contribute to pain
peripheral sensitization
referred pain
lowering the threshold for a peripheral pain neuron. Reducing the stimulus necessary to depolarize a nocicepter
peripheral sensitization
example of an injury that reduces the threshold for nocicepters
sunburn
Pain that comes from a visceral organ that is perceived in a somatic part of the body
referred pain
example of referred pain
heart attack (L arm aches)
Carry proprioceptive information from peripheral sensory receptors (touch, joint, muscle)
unconscious relay tracts
structures that process and regulate pain and are capable of creating pain perception in the absence of nociceptive input. The pain pathway from start to finish
the pain matrix
3 aspects of pain
sensory-discriminative aspect
motivational-affective aspect
cognitive-evaluative aspect
top down inhibition of pain signals or anything that inhibits the transmission of pain message
antinociception
anything that either lets the pain through or amplifies it. biological amplification of pain signals
pronociception
Where is level I of Pain Matrix
periphery
Where is level II of Pain Matrix
dorsal horn
Where is level III of Pain Matrix
brain stem
Where is level IV of Pain Matrix
hypothalamus and pituitary
2 ways to turn on level IV
aerobic exercise and modalities like TENS
Where is level V of Pain Matrix
cerebral cortex
How can you turn on level V
being supportive and caring therapist
causes of chronic pain
Continuing tissue damage
Environmental factors (operant conditioning)
Sensitization of nociceptive pathway neurons
Dysfunction of endogenous pain control system
cause of acute pain
Threat of or actual tissue damage
Pain that extends beyond the time expected for normal tissue healing
chronic pain
Continuing pain stimulus
Pain neurons functioning normally
nociceptive
No continuing pain stimulus
Pain neurons typically NOT functioning normally
neuropathic
2 categories of chronic pain
nociceptive and neuropathic
extra sensation that appears without identifiable stimulus that is typically described as not painful or uncomfortable
paresthesia
extra sensation that appears without identifiable stimulus that is typically described as unpleasant or painful
dysesthesia
a dysesthesia where pain/discomfort is perceived after a stimulus that shouldn’t cause pain
allodynia
a dysestehesia where a person perceives heightened pain from a stimulus that would normally produce mild pain
Secondary hyperalgesia
4 mechanisms of neuropathic pain
- Ectopic foci
- Ephaptic transmission
- Central sensitization
- Structural reorganization
places along the pain pathway where a pain signal can be started without depolarizing nociceptors
ectopic foci
2 parallel neurons (1 touch, 1 pain) get demyelinated and signals can short-circuit
ephaptic transmission
long term potentiation or strengthening the synapse of the pain pathway. “Learning in the pain pathway”
central sensitization
pain neuron sensitizes the synapse and withdraws from synapse since it is no longer signaling. Touch neuron synapse on pain neurons via collateral sprouting in the dorsal horn
structural reorganization
sensation that seems to originate from the missing limb.
phantom limb sensation
how to neurons that don’t get input try to adapt
- become hypersensitive (denervation hypersensitivity)
2. generate action potentials with very little or no stimuli
what are ways we can provide therapy for phantom limb pain
mental practice, movement therapy, and mirror therapy,
what does the autonomic nervous system regulate
Circulation Respiration Digestion Metabolism Secretions Body temperature Reproduction
uses energy, efferent projections have a thoracolumbar outflow, fight or flight
sympathetic nervous system
stores energy, efferent projections have a craniosacral outflow. Rest and digest
parasympathetic nervous system
sympathetic effect on vessel wall in the skin
vasoconstriction of arterioles
purpose of vasoconstriction of arterioles
decrease radiation of heat from the skin
sympathetic effect on vessel wall in skeletal muscle
vasoconstriction of veins and venues
purpose of vasoconstriction of veins and venules
increase blood pressure and increase peripheral vasculature resistance
sympathetic effect on vessel wall in the heart
dilation
purpose of dilation in the heart vessel wall
increase blood available to heart
receptors of the autonomic system
mechanoreceptors
chemoreceptors
nocireceptors
thermoreceptors
example of receptor in carotid sinus there are stretch receptors that stretches in response to changes in blood pressure. Signals brain about changes in BP
mechanoreceptor (stretch and pressure)
receptors found around hypothalamus that sample CO2.
chemoreceptors (chemical environment)
receptors that indicate stretch that could hurt or ischemia (lack of blood flow that could hurt you)
nociceptors
receptors that sample temperature of blood and make adjustments if necessary
thermoreceptors
information from visceral receptors enters the CNS by which 2 routes
into spinal cord via dorsal roots and into brainstem via cranial nerves
which cranial nerves send signals from viscera of head, thorax, and upper abdomen . Bring in majority of afferent information from viscera system.
facial 7, glossopharyngeal 9, and vagus 10
The lower abdomen and all of the receptors from out in the body get to the brain through the _____ and up the spinal cord
peripheral nerves
4 afferent responses of a visceral organ
- mobilizes the body-wide autonomic system (spinolimbic)
- tells you grossly what’s hurting/referred pain (spinothalamic)
- shuts off the visceral organ that’s sending the pain signal
- mobilizes the somatic structures to guard it
neurons of the sympathetic system inside the CNS
modulatory, control
efferent neurons that ultimately control the shots in terms of efferent response to maintain homeostasis. Start at base of brain and extend down to brainstem.
modulatory neurons
have cell body in brainstem and send axon down. Gather all modulatory input , boil it down into a plan, and initiate efferent response
control neurons
neurons of the parasympathetic system inside the CNS
modulatory, control
2 peripheral autonomic neurons that are efferent
pre-ganglionic and post-ganglionic
where is the cell bodies of pre-ganglionic neurons
inside the CNS
what do post-ganglionic neurons make contact with
visceral organs
what are the 3 neurotransmitters of the autonomic system
acetylcholine, epinephrine, and norepinephrine
Neurotransmitter of neuromuscular junction AND of the parasympathetic connected to our viscera.
acetylcholine
primarily the sympathetic neurotransmitter that’s released from the adrenal gland into the blood stream. Connects anywhere where there is a good receptor.
epinephrine
sympathetic neurotransmitter of direct connections to viscera
norepinephrine
where do the axons of control neurons come down the spinal cord
lateral column of spinal cord
where are the cell bodies of pre-ganglionic peripheral efferent neurons
lateral horn of spinal cord
what range of spinal levels are the cell bodies of pre-ganglionic peripheral efferent neurons found in SNS
T1-L2
dumps epinephrine into blood. By doing so, mobilizes a body-wide sympathetic response through the blood supply. Tends to raise the metabolism of every cell it comes in contact with.
adrenal medulla
which system regulates temperature
sympathetic
what 2 ways does sympathetic system regulate temperature
sweating and shunting
norepinephrine receptors in heart vessels tend to
dilate
norepinephrine receptors in muscle arterioles tend to
constrict
what does the sympathetic system do to control in the head
dilate pupil, elevate upper eyelid, and produces thick saliva
what does the sympathetic system do to the heart
increases the rate and contractility of the heart
what does the sympathetic system do to the lungs
dilates bronchial tree and airway
what does the sympathetic system do to the GI tract
decreases blood flow
decreases peristalsis
decreases secretions
inhibits contraction bladder and bowel
what does sympathetic system do to metabolism
increases
what does parasympathetic system do to the heart
slow down
what does parasympathetic system do to the bronchial tree
constriction of airways
what does parasympathetic system do to the salivary glands
thin saliva
what does parasympathetic system do to the eye
constricts pupil and increases curvature of lens
what does parasympathetic system do to GI tract
increase secretions
increase peristalsis
glycogen synthesis
empties bladder/bowel
what controls bowel/bladder
synergistic (para empty symp not empty)
what controls HR
synergistic (rate)
what controls blood vessels
unopposed SNS
the only autonomic fibers in your peripheral nerves are
sympathetic
what controls sweat glands
unopposed SNS
what controls lens of eye
unopposed PNS
what controls external genitalia
unopposed PNS
What causes: Drooping eyelid Constriction of pupil Flushing (vasodilation) Absence of sweating
Horner’s syndrome (lack of SNS to one side of head)
caused by damage to the stellate ganglion
Horner’s syndrome
SNS doesn’t reduce capacitance
Venues don’t return their blood to the circulation
Factor of an insufficient SNS
postural hypotension
Decrease of BP during the first 3 minutes of standing
orthostatic hypotension
when testing orthostatic hypotension, it is considered abnormal if there is a drop of more than ___ mm HG systolic and more than ___ mm HG diastolic
30, 15
balance control in reaction to destabilizing force
feedback balance control
balance control in anticipation
feedforward balance control
voluntarily or involuntarily contracting muscles on both sides of a joint or body segment
cocontraction
causes the spindle to always be sensitive during active movements
alpha-gamma coactivation
A lower motor neuron and all the muscle fibers it innervates
motor unit
Motor units that are: Smaller diameter A-alpha Oxidative metabolism Lower tension More fatigue-resistant
slow twitch
Motor units that are: Larger diameter A-alpha Glycolytic metabolism Higher tension Less fatigue-resistant
fast twitch
principle where brain starts with slow twitch and recruits fast twitch as necessary
Henneman’s size principle
horizontal organization of LMN matches medial with ___ mm
proximal
horizontal organization of LMN matches lateral with ___ mm
distal
when the agonist muscle is facilitated, the antagonist muscle is inhibited or relaxed to allow movement around a joint
reciprocal inhibition
Group of muscles that work together under good, voluntary control in any pattern desired for function
normal synergy
a group of muscles that work together under limited voluntary control in a limited number of patterns that may or may not contribute to function
abnormal synergy
without looking, we have an idea of how our body is arranged in space
proprioceptive body schema
role of golgi tendon organs
uses the tension of muscles to refine voluntary movements
a network of neurons that supports automatic walking
stepping pattern generators
testing reflexes tells you
the integrity of the sensory and motor neuron loop
Relationship between reflexive and voluntary movement
spinal region coordination
Project from cortical and brainstem movement centers to lower motor neurons (LMN) of cranial and spinal nerves
UMN
medial UMN origin that gives more direct voluntary control of movement.
cortical origin
medial UMN origin that support voluntary movement (guided by medial and lateral cortical pathways). Smaller degree of voluntary control
subcortical origin
lateral UMN origin that gives direct voluntary control. Influences and guides activity of supporting medial group pathways
cortical origin
lateral UMN origin that supports and complements direct voluntary control
subcortical origin
UMN tract that helps to pick stuff up against gravity (flexion)
Broad distribution upper and lower
Postural muscles
Gross limb movements
Lower degree of direct voluntary control
reticulospinal
medial UMN tract that projects to neck and upper back postural muscles
Helps maintain upright against gravity (extension against gravity)
Lower degree of direct voluntary control
medial Vestibulospinal
medial UMN tract that projects to axial and lower extremity extensors
Helps maintain upright against gravity
Lower degree of direct voluntary control
lateral vestibulospinal
medial UMN tract that projects to medial motor neuron pools bilaterally
Voluntary control of neck, shoulder and trunk muscles
Higher degree of direct voluntary control
medial corticospinal
lateral UMN tract that is Most important pathway for voluntary movement
“Fractionated” movement
Direct control of distal muscles
Guiding control of postural support muscles
lateral corticospinal
lateral UMN tract
Small pathway
Minor control of distal extensor muscles of upper extremities
rubrospinal
