Neuro-Essentials Flashcards
NS–Specialized cells that receive, integrate, control, and transmit info t/o body
Components of NS?
- CNS
- PNS
- ANS
- Somatic NS (SNS)
- Limbic System
CNS: Brain + SC
2 hemispheres containing: and further divided:
- Frontal, Parietal, Temporal, Occipital lobes
- Forebrain (Prosencephalon), Midbrain (Mesencephalon), Hindbrain (Rhombencephalon)
Ea responsible for interpretation and control of bio processes + mvt
PNS has _ pairs cranial nerves; _ pairs spinal nerves
Responsible for?
12 pairs cranial nerves (Oh Oh Oh To Touch And Feel Virgin Girls Vaginas And Hymens) (Some Say Marry Money But My Brother Says Big Boobs Matter More)
31 pairs spinal nerves
All have Afferent (sensory, dorsal) and Efferent (motor, ventral) fibers
For communication bw body and CNS
ANS has 2 divisions:
- sympathetic (stimulating)
- Parasympathetic (inhibitory)
ANS contains portions of CNS and PNS
- impulses to ANS typ do NOT reach lvl of consciousness– produce automatic responses
Somatic Nervous System (SNS)
Does what?
- Regulates body mvmt thru sensory and motor neurons–transmit info from brain to mm fibers
- Controls: Voluntary body mvmt, influences the 5 senses, responsible for reflex arcs such as DTRs
Limbic System found where and does what?
- Found w/in Brain
- Involved with: control and express of mood, processing, memory, appetite, olfaction
- Lesions: aggression, fearlessness, alterations in motivation, other
Forebrain (Prosencephalon)
Consists of what and whats found there?
- Telencephalon– cerebral cortex, hippocampus, basal ganglia, amygdala)
- Diencephalon– (all the “alamus’s)–Thalamus, Hypothalamus, subthalamus, epithalamus
Cerebrum consists of _ and _ , while sulci/fissures demark what?
- Gray matter–Surface
- White matter–Interiorly
- Sulci/Fissures– demark specific lobes
Hemispheres L vs R:
Left Hemisphere
- Ability to understand language
- Sequencing of mvmts
- Producing written/spoken lang
- Expression of + emotions
- Ability to be analytical, controlled, logical
Hemispheres L vs R:
Right Hemisphere
- Nonverbal processing
- Artistic expression
- Comprehension of general concepts
- **Spatial Relationships
- Kinesthetic awareness**
- Mathematical reasoning
- Body Image awareness
Each lobe of the brain has responsibilities:
Frontal Lobe
- Intellect, Orientation, Voluntary mvmt, Broca’s, Executive functions
Each lobe of brain has responsibilities:
Parietal Lobe
- Receives info assocd w/ touch, kinesthesia, vibration
Ea lobe has responsibilities:
Temporal
- Auditory, Wernicke’s, production of meaningful speech
Ea Lobe has responsibilities:
Occipital
- Visual processing, judgement of distance, vision in 3D
Midbrain located where and consists of what?
- @ Base of brain ABOVE SC
- Tectum/Tegmentum (the T’s)
- Relay Area– connects forebrain->Hindbrain
- Reflex Center– visual, auditory, tactile responses
Hindbrain consists of what?
- Cerebellum, PONs, Medulla oblongata
- Cerebellum– coords mvmt + assists w/ maintenance of balance (When Dr. Cohen says Cerebellum, you say COORDINATION!!!)
- PONS + Medulla– assist w/ control of bodys vital functions
Circle of Willis
AA’s?
Anterior Cerebral AA, Middle Cerebral AA, Posterior Cerebral AA, Vertebral-Basilar AA perfuse diff regions of brain and will produce impairments w/ vascular patho specific to each.
Meninges
What do they do? What are they called?
3 layers connect tissue provide covering/protection for brain/SC
Outer to Inner–> Dura mater-Arachnoid mater-Pia mater
- Dural spaces surround meninges & contain CSF
What is CSF? What assists to produce CSF?
- Clear fluid-like sub that cushions brain/SC and provides nutrition
- Ventricular system assists to produe and circulate
Spinal Cord
- comp of CNS–direct continuation of BS
- Relay for info bw brain and peripheral structures
- Spinal nerves ea possess afferent and efferent fibers for transm. of info thru ascending (sensory) and descending (motor) tracts of SC
Peripheral Nervous System
- Nerves that have sensory, motor, and autonomic responsibilities
- Cutaneous sensory end organs–> thermo, noci, mechano, chemo, and photoreceptors—— provide feedback thru diff channels of stimulation
Peripheral nerve fibers classified as_and describe each
A, B, C
A, B, C
-A= Lg/myelinated with HIGH conduction speed
B= Med/myelinated w/ MOD speed
C= Sm/UNmyelinated or poorly myelinated w/ SLOW speed
Derms/Myotomes stem from what nerve roots?
C1 thru S4
- ea innervate a particular region for Sensation (dermatome) and Motor Innervation (Myotome) — provide pattern for anticipated weakness w/ impairment
List the Cranial Nerves
- Oh–Olfactory (sensory)
- Oh–Optic (sensory)
- Oh–Oculomotor (motor)
- To–Trochlear (motor)
- Touch–Trigeminal (both)
- And–Abducens (motor)
- Feel–Facial (both)
- Virgin–Vestibulocochlear (sensory)
- Girls–Glossopharyngeal (both)
- Vaginas–Vagus (boobs)
- And–Spinal Accessory (motor)
- Hymens–Hypoglossal (motor)
Plexuses and where they innervate
- Brachial Plexus== UE
- Lumbar and Sacral Plexus== LE
Superficial Reflexes–How they Work
Normal vs Abnormal
- Response to stimulation of the receptors w/in skin—Sensory signal must reach SC and Ascend to brain for processing
- Common NORM superf reflexes== abdominal, corneal, cremasteric, gag, plantar reflexes
- Abnormal== Babinski (abnorm plantar reflex)
Deep Tendon Reflexes
- Elicit mm contraction thru stimulation of mm tendon thru reflex arc
- Graded 0-4+—– results may be indicative of a lesion TO reflex arc OR a suprasegmental lesion
Superficial Sensations —-
Lt touch, temp, PAIN
Deep sensations—-
Kinesthesia, Proprio, Vibration
Cortical sensations—-
Localization of touch, B/L simultaneous stimulation, 2pt discrim, stereognosis, barognosis
Acute injury to a peripheral N. will produce 3 nerve pathologies
List from LEAST severe to MOST
- Neurapraxia
- Axonotmesis
- Neurotmesis
see medcon 1!!!
Acute injury to a peripheral N. will produce 3 nerve pathologies
Neurapraxia
MILDEST
- axons preserved and recovery rapid and complete
Acute injury to a peripheral N. will produce 3 nerve pathologies:
Axonotmesis
MORE Severe
- Reversible damage, potential for spontaneous recovery
Acute injury to a peripheral N. will produce 3 nerve pathologies:
Neurotmesis
the “requires sx” one
MOST SEVERE
- Axon AND myelin are damaged
- Irreversible injury
- NO spont. recovery
- Sx MAY allow for SOME recovery *****
UMN Lesions
**Found where? Characteristics? **
- Found w/in motor cortex, internal cap, BS or SC
- Characteristics: HypERactive reflexes, MILD atrophy, INCd tone
LMN Lesions
Found where? Characteristics?
Found IN nerves or their axons @ or BELOW lvl of BS
- Characteristics:HypOactive or absent reflexes, atrophy, fasciculations, DECd tone (hypOtonia)
ALL mvmt disorders that present w/ INvoluntary mvmts
- Tremos, tics, chorea, dystonia, athetosis
Mvmt disorders
What is Balance?
Components of Balance?
Somatosensory + Vision + Vestibular—provide feedback to CNS
- State of phys equilibrium w/ maintenance and control of the COG
VOR vs VSR
- VOR: supports GAZE STAB. thru eye mvmt that COUNTERS mvmts of head
- VSR: attempts to stabilize BODY while HEAD is moving in order to manage upright posture
Vestibular Rehab
Indications? Includes?
- Pts w/ central or peripheral balacne disorders
- Includes: VOR/VSR ex’s, ocularmotor ex’s, habituation training, balance, COG control, varying environments, visual cond’s, use of gravity to challenge balance system
Communication Disorders
- can include ALL forms of aphasia, verbal aPraxia (planning), and dysarthria (swallowing)
- Aphasia–receptive, expressive or global
- Tx is modified based on pts ability to communicate or understand altern. forms of comm.
Common Pharma agents for neurological disorders?
- Antiepileptic agents
- Antispasticity agents
- Cholinergic agents (mvmt disorders?)
- Dopamine replacement agents
- MM relaxant agents
CVA
How are they termed?
- Specific event results in lack of O2 to specific area of brain secondary to ischemia or hemorrhage
- Termed: Completed stroke, stroke in evolution, TIA, ischemic or hemorrhage
Predictable patterns of impairment w/ CVA
KNOW THEM!!!
Pt presents w/ predictable patterns of impairment when ischemia occurs seconary to CVA in L hemisphere, R hemisphere, BS or Cerebellum
YOU KNOW THEM!!!
Flexor vs Extensory Synergy UE
Flexor Synergy
- Scapular elevation w/ retraction; Shoulder ABD and ER; Elbow flexion; Forearm supination; Wrist flexion; finger and thumb flexion w/ ADD
See neuroPT spasticity!!!
Flexor vs Extensory Synergy UE
Extensor Synergy
- Scapular depression and protraction; Shoulder ADD and IR; Elbow EXT; Forearm PRO; Wrist EXT; Finger and thumb flexion w/ adduction
see neuroPT!!!
Flexor vs Extensor Synergy: LE
Flexor Synergy
- Hip ABD and ER; Knee flexion; Ankle DF w/ SUP; Toe EXT
Flexor vs Extensor Synergy: LE
Extensor Synergy
- Hip EXT, IR, ADD; Knee EXT; ankle PF w/ inversion; Toe flexion and ADD
Neurological rehab
May incorp variety of treatments based on pts patho/goals
- Variety of constructs base ea of the theories of rehab on particular interpretation of motor control and motor learning (cognitive, associative, autonomous)
Motor CONTROL
Study of NATURE of mvmt and ability to direct essential mvmt
Motor LEARNING
Study of the acquisition or modification of mvmt
- Stages: Cognitive, Associative, Autonomous
- NOTE: FEEDBACK is imperative for progression of Motor Learning (concurrent and knowledge of performance is best)
_ is integral to Motor Learning
and types?
PRACTICE!!!!
- TYPES: Massed and distributed; constant and variable; random and blocked; whole training vs part training
see neuroPT!!!
Who developed Neuro-Developmental Treatment ?
NDT
Bobath
see neuroPT!!!
Bobath developed NDT based on hierarchial model of neurophysiologic function
Includes?
- Includes: Facilitation/inhibition of tone, Reflex Inhibiting Postures (RIPs), Key pts of control, Proximal control, Use of Rotation
See neuroPT!!! and labs!!!
Brunnstrom vs Raimiste’s vs Souque’s
- Brunnstrom Mvmt Therapy in Hemiplegia– utilizes synergy patterns to assist w/ developing mvmt combos OUTSIDE of synergy patterns (scale)
- Raimiste’s phenomenon and Souque’s phenomenon– used in tx along w/ Assocd rxns, stages of recovery, overflow, limb synergies
PNF
- based on establishing GROSS motor patterns w/in CNS– allows for stronger parts to stim/strengthen weaker parts
- Tx emphasizes developmental sequence, mass mvmt patterns, and diagonal patterns
Rood’s Theory of Neurological Rehab
the “Reflex” one
- Based on reflex stimulus model where motor OUTput is the result of past and present sensory INput
- Goal of homeostasis achieved using key patterns to enhance motor control
- Tx: Sensory stim to facilitate or inhibit a response
SCI
- PERM damage can occur to SC after suff force exerted
- MVAs==highest incidence
- Comp vs Incomp w/ regard to motor and sensory function
Incomplete SCI’s include
see neuroPT and Neurophysiology
- Anterior cord, Brown-Sequard’s, Central Cord, Posterior Cord, Cauda Equina
see EARLY NEURO AND QUIZLETS!!!
ASSESSES Pts w/ SCI
ASIA Scale
- A->E (worst to better)
Autonomic Dysreflexia common comp of what and considered what?
SCI; MEDICAL EMERGENCY!!!
SIT THEM UP!! TO LOWER BP
AUTONOMIC DYSREFLEXIA
MEDICAL EMERGENCY!!!
- Excess. and Uncontrolled INC in BP places pt @ risk
- Kinked catheter is most typ stimulus
KNOW THE LVLS OF SCI AND WHAT CORRELATES TO EACH
PT MUST be able to recognize pts potential based on expected functional outcomes
TBI Classifications and Primary vs Secondary
- Classified as Open or Closed w/ Primary and Secondary brain damage
- Primary== coup/contrecoup lesions
- Secondary==typ due to epidural or subdural hematoma
Glasgow Coma Scale
see notes/scales to know
- Assess pts w/ suspected head injury in order to classify injury from mild-severe
<8== Coma
RLA Levels of Cognitive Functioning Scale
assist to classify injury based on where pt best meets criteria
Levels:
- No response
- Generalized response
- Localized response
- Confused-agitated
- Confused-innapropriate
- Confused-appropriate
- Automatic-appropriate
- Purposeful-appropriate
Concepts of Development
(4)
- Cephalic to Caudal (head to tail)
- Gross to fine
- Mass to specific
- Proximal to distal
Primitive Reflexes
see PEDS!!!
- Elicited w/ predictable stim which causes predictable response until time when reflex is integrated
- When reflexes DO NOT integrate, there is typ interference w/ progressing thru dev. milestones
Developmental Milestones for Gross and Fine Motor skills
- follow tentative schedule thru teenage yrs
- Dev. delay OR other ped patho may cause child to exp difficulty progressing thru milestones
ESSENTIAL to obtain MAX function for pediatric population
Therapeutic Positioning
More on Therapeutic positioning:
used to facilitate desired mvmt, inhibit unwanted tonal influenes, normalize tone, prevent contractures, enhance midline orientation, improve respiratory capacity
Services and Benefits for Children w/ Disabilities
Legislation
Individuals w/ Disabilities Education Improvement Act (IDEA), Rehabilitation Act, No Child Left Behind Act
