Neuromuscular and Nervous System Flashcards
What is the CNS comprised of and what are its characteristics?
Made up of the brain + brain stem+ spine
- has white and gray matter that has either mylinated on non-mylinated axons and the diff regions of the brain,.
The white matter has 3 diff funiculli regions; dorsal, lateral and anterior columns.
What is the PNS comprised of and what are its characteristics?
Made up of cranial nerves, associated ganglia and spinal nerves, associated ganglia and plexus
- there are 12 pairs cranial nerves that exit skull foramina
- 31 pairs of spinal nerves exit intervetebral foramina
- 8 cerv, 12 thor, 5 lumbar, 5 sacral 1 coc
take info to the CNS
spinal nerves have anterior efferent fibers take motor info away from CNS (AME) and posterior roots that take sensory info to the CNS via afferent fibers (PAS)
What is the autonomic system ANS comprised of and what are its characteristics?
makes up the para and sympthetic system which is in part made up of the CNS and PNS anatomy.
- automatic responses for homeostasis and stress that do nto reach conscious level
What is the somatic system SNS comprised of and what are its characteristics?
made up of peripheral and motor nerve fibers
takes motor info away from CNS and sensory info to the CNS
- somatic motor neurons will innervate skeletal muscle directly without synapsing
- controls all 5 senses
- all fibers are myelinated
What is the limbic comprised of and what are its characteristics?
made up of the corpus callosum, olfactory tract, mamillary bodies, thalamic nuclei, amygdala, hippocampus and hypothalamic nucli
Purpose: control emption, recent memory, appetite (food+ mood)
- can lead to changes in mood, behavior, fear, sexual behanvior and motivation change.
What are physiologic functions that the ANS controls. What could dysfxn of the ANS lead to?
- control BP, saliva, sweat, HR, tears,urination, defication, sexual arousal, breathing, homestasis, pupil dilation
- horners, ED, constipation, vasovagal syncope, orthostatic hypotension, tachycardia syndrome
what does the left brain do
3 Ls: Logic, Love Language language; understand, written and spoken, process verbally coded info in organized manner analytic sequence and perform movements control logical rational math calculations positive emotions; love, happiness
what does the right brain do
non verbal processing / communication art general concept comprehension hand- eye coordiantion spatial relationships kinestetic awareness non verbal communication math reasoning express negative emotions body image awareness
what functions and impairments may occur at the frontal lobe
- the frontal lobe includes the primary premotor cortex and the precentral gyrus which enables voluntary movement.
- brocca’s area, usually in the left, produces speech and concentration
- personality, temper, judgement, reasoning, behavior, self awareness, and executive functions come from the frontal lobe
- impairments: CONTRA weakness, persevation, inattention, personality change, antisocial, apathy, Broccas aphasia (expressive), delayed/ poor initiation, emotional liability
what functions and impairments may occur at the parietal lobe ?
- sense of touch, kinesthesia, perception of vibration and temperature
- gets info about hearing , vision, motor, sensory, and memory
- meaning for objects
- interpret lang/ words
- spatial and visual perception
- impairments: most people will have L cerebrum dominance (Dom R hand) and will have agraphia, alexia, or agnosia.
- non dom hemisphere involvement (R side); dressing apraxia, constructual apraxia and anosognosia
what functions and impairments may occur at the temporal lobe ?
- auditory and smelling
- wernike’s (on left side) which gives abilty to understand/ produce meaningful speech understanding lang, verbal and general memory
- interpretation of emotions and reactions
impairment: learning deficit, wernike’s aphasia (receptive) antisocial and aggressive behavior . Difficulty to categorize objects, recognize faces, memory loss
what functions and impairments may occur at the occipital lobe ?
- main center for processing visual info regarding shapes, light, and color. Determines distance and seeign in 3-D
Impairment: homonymous hemianopsia, imparied extra ocular mus movement and visual deficits, impareid color recognition, reading/writing impairment, cortical blindness with lobe involvement
** L homonymous hemianopsia will occur to a lesion on the R occipital lobe or optic tract and will tkae out the L field of vission on both eyes.
what does the hippocampus do?
- part of the cerebrum
stores memories - what does a hippo look like
- H is for history
what do the Basal ganglia do?
- part of the cerebrum
- deep in the white matter (white matter of cerebrum= cortex, outside=gray)
- includes the caudate, putamen, globus pallidus, substantia nigra and subthalamic nuclei.
- in charge of voluntary movement, and regulation of autonomic movement such as posture, tone, motor responses.
- WITH DAMAGE: tone does not change with speed and persists on both sides of the joint
- associated with huntingtons, OCD, addictive behavior, parkinsons, ADD, and tourettes.
what does the amygdala do?
- part of the telecephalon
- in the temporal lobes
- in charge of emotional and social processing
- fear and arousal, emotioanl memories
what is the telecephalon made up of?
also known as cerebrum
Hemispheres; Lobes (temporal, parietal, frontal, occipital,)
BG, amygala,
hippocampus.
Separated by fissures and sulci.
billions of neurons and glia make up the cerbral cortex
“CAHB” Cerbrun, hippocampus, amygdala, basal ganglia
what does the Thalamus do?
- Cerebellum, sensory (except olfactory) BG info > cerebral cortex.
- Gather info from sensory perception and movement from the cerebellum, BG and sensory pathways and will take info to appropriate association cortex for contralateral side.
- Thalamic pain syndrome: spontaneous pain on contralateral side of body
what does the subthalamus do?
- regulates movements for skeletal mus.
- associated with the BG and substanita nigra
what does the epithalamus do?
- also the pineal gland, which secretes melatonin
- helps with the internal alarm clock, secretion of melatonin and circadian rhythms
what does the Hypohalamus do?
gets info from the autonomic nervous system to regulate hormones and associated fxns such as sex drive, temp, adrenal glands, pituitary axis thirst and hunger.
what is included in the midbrain?
tectum - superior / inferior colliculi,
tegmentum - Sub nigra, peri aqueductal gray, cerebral aquaduct, reticular formation, red nucleus
what makes up the hindbrain ?
pons, medulla, cerebellum
brain stem - pons and medulla oblongata
what does the cerebellum do?
refines movement like posture and balance by control of proprioception and tone.
Control of rapid alternating movements.
In charge of IPSIlateral movement
impairment: will present on IPSI side of the body. Ataxia, nystagmus, hypermetria, poor coordination and deficits in reflexes, balance and equilibrium
What does the pons do? Where is it located in the brain ?
located in the cerebellum of the hindbrain (rhombencephalon)
- in charge of respiration
- orientation of the head in response to auditory and visual stimuli
- CN 5-8 originate from the pons
What does the medulla oblongata do? Where is it located in the brain ?
- in charge or ANS fxns such as breathing/ HR
- reflexes for coughing, sneezing, vomiting
- control of sleep
- somatic sensory info from organs
- Origin of CNs 9-12
What is meningitis? how is it diagnosed? What are the signs and symptoms?
- inflamation of the meninges by bacterial infection most often. Can be deadly in hours
- lumbar puncture is gold standard in dx. Tx with antibiotics, antibacterials and steriods. Epidural/ puncture will be at L3/L4, below where spinal cord ends at L1/2
SIGNS AND SYMPS:
Fever
stiff painful neck
lumbar pain
+ brudinskis sign; flexion of neck helps flex hip and knees
+ kernigs sign: pn with hip flexion and knee extension
light sensitivity
what is kernig sign?
pain with Knee extension and hip flexion combined movement
what type of info do ascending spinal tracts send and in which direction?
Ascending tracts receive afferent (sensory, DAS) from spinal ganglia interneurons, or gray matter and send the info to the cerebellum/ cerebrum. Tracts include:
- fasciculus cuneatus/gracilus tract
- spinocerebellar; dorsal and ventral tract
- spinoolivary tract
- spinoreticular tract
- spinotectal tract
- spinothalamic; anterior and lateral tract
fasciculus cuneatus tract
proprioception, vibration and 2 point discrimination, and graphesthesia for the UE
- dosal tract
fasciculus cuneatus/gracilus
cuneatus: proprioception, vibration and 2 point discrimination, and graphesthesia for the UE, trunk and neck
gracilus: proprioception, vibration and 2 point discrimination, and graphesthesia for the LE and trunk
spinocerebellar; dorsal and ventral tract
- proprioception
- muscle tension
- joint sense
- posture
dorsal- ispilateral subconscious proprioception, muscle tension, joint sense and posture in the LE and trunk
ventral - ispilateral subconscious proprioception, muscle tension, joint sense and posture in the UE , LE and trunk. decussation at the pons.
spinoolivary tract
relays info from cutaneous and proprioceptive organs
spinoreticular tract
influences levels of consciousness
spinotectal tract
assists with movement of the eyes and the head towards a stimulus
spinothalamic; anterior and lateral tract
anterior - crude touch and pressure
lateral - pain and temperature
what type of info do descending spinal tracts send and in which direction?
Descending tracts carry efferent (motor VEM) info such as voluntary mus fxn, tone, equilibrium, and visceral innervation to the spinal cord form area in the brain such as the cerebral cortex, pons, midbrain and medulla
corticospinal; anterior and lateral tract reticulospinal tract rubrospinal tract tectospinal tract vestibulospinal tract
corticospinal; anterior and lateral tract
anterior - voluntary, discrete and skilled movements pyramidal motor tracts for ipsi motor movement.
lateral- contralateral fine movement. Very important for fractionated movement by inhibiting unwanted movement
damage to these tracts will result in a + babinski sign, superficial abdominal signs, cremasteric reflex. and loss for voluntary of fine motor control
only tracts that are pyramidal, all others are extra pyramidal.
reticulospinal tract
facilitation or inhibition of reflexes via alpha and gamma motor neurons
- Essential for coordinating muscle activity for trunk and proximal muscles of the 4 limbs during walking
- involved with APAs and reaching
- When disrupted can lead to a flexor synergy motor pattern
rubrospinal tract
motor input for gross postural tone, facilitates flexor muscles and inhibits extensor muscles
tectospinal tract
responsible for contralateral postural tone associated with visual and auditory stimuli
vestibulospinal tract
reposnsible for ipsilateral gross postural adjustments before head movement.
Facilitates extensor mus, inhibits flexors.
damage to extrapyramidal tracts leads to exaggerated DTRs and clasp-knife rxn
what does damage to the extrapyramidal tracts do?
paralysis, hypertonicity, increased DTR, and clasp knife reaction.
How should you asses balance?
assess visual, vestibular and somatosensory integration
explain somaosensory input
receptors in the skin, joints, ligaments, tendons and muscle provide propriocpetive info from the ankle, hips, neck ect to the brain about balance
Do children rely more or less on the visual system for balance?
more so
what is required of the vision system for succcsful balance?
Visual field cuts, hemianopsie, pursuits, saccades, double vision, gaze control, and acutiy are nessesacy
What Is the vestibular ocular reflex (VOR)
allows for head and eye movement coordination
stable image is fixed on the retina as the head moves.
Supports gaze stabilization through eye movement
What is the vestibulospinal reflex (VSR)
Attempts to stabilize the body and control movement
stability and control of the head and trunk with upright posture
What the difference btwn VOR and the VOR cancelation reflex?
VOR exam: the patient looks at 1 target and rotates head
VOR cancelation: the patient has fixed gaze on moving target while head is moving
When is the ankle strategy elicited ?
1st Strategy to be elicited with loss of balance
- will occur with slow velocity and small range perturbation with feet on ground
- muscle contracts distal to proximal to control sway at ankle
When is the hip strategy elecited
when greater force, challenge or perturbation happens through hip or pelvis
- hips move in opposite direction of head
- with loss of balance muscles contract proximal to distal
What is the suspensory strategy
- Center of gravity is lowered in order to better control balance.
- Knee flexion crouching are squatting or often used.
- Strategy is used when mobility and stability or quired in a task like in surfing
What is a step in strategy?
unexpected challenge or perturbation in statis stnading or when center of gravity is outside BOS, the LE or UE reach to regain new BOS postion
Can vertigo have a central or perioheral origin?
yes, both can be sources of vertigo
what are characteristics of peripheral vertigo? What are causes a peripheral vertigo?
Episodic a short duration.
- Autonomic symptoms present.
- Precipitating factor.
- Pallor, sweating, nausea and vomiting.
- Auditory fullness forms within the ears
- tinitis
Can be caised by: BBPV Meniere's disease infection trauma/tumor metabolic disorders; diabetes acute alcohol intoxication
what are characteristics and causes of central vertigo?
-Atonomic symptoms less severe.
- Loss of consciousness can occur.
Diplopia
hemianoopsia
weakness numbness
ataxia
dysarthria
Can be caused by: meningitis migraine headache complications of neuro origin post ear infection trauma/tumor cerebellar degeneration (alcoholism) MS
What canal is mostly affected by BPPV
Posterior semicircular Canal
Is congential nystagmous generally mild and not usuallly associated with a patholgy?
yes
What causes spontaneous nystagmous ?
imbalnace of vestibular signals to the oculomotor neurons which causes a drift to 1 side that is countered by quick movement to 1 direction
- typically alsts 24 hrs
- typically happens after acute vertibualr nerve leison
what is the main differece btwn central and peripheral nnystagmous?
peripheral nystagmus will resolve with fixed gaxe on object, occurs with a lesion to a peripheral nerve
- central nystagum happs when there is a leision on the brainstem or cerebellum. It is not inhibited by visual fixation
- visual fixation and lesion location are 2 main differences
what ellicits postional nystagmus?
change in head position
semicircular canals will stimulate nystagmus that will only last a few seconds
what will ellicit gaze evoked nystagmus ?
when eyes go from primary postion to alternate postion
caused by inability to maintian stable gaze postion
- associated with CNS injury, brain injury or MS
What are the symptoms of nystagmus due to a central lesion ?
direction : bi or unidirection
visual fixation: no habituation with fiaxtion
verigo: mild
length of symptoms: May be chronic
etiology: demyelination, vascular leision, cancer/ tumor
What are the symptoms of nystagmus due to a peripheral lesion ?
direction : unidirectional with fast segment of movement indicating opposite direction of lesion
visual fixation: will inhibit with nystagmus and vertigo
vertigo: significant
length of symptoms: mins, days, weeks, finite period of time, recurrent
Etiology: Meniere’s, vascular disorders, trauma, toxicity, infection of inner ear
when would you use the berg balance scale ?
Determine fall risk
- 14 tasks scored 0-4 (5 points possible)
- tests sitting and standing postures in static, dynamic, and tranistions
- max score 56
- < 45 = fall risk
when would you use the fregly- graybiel ataxia test battery
Assess and treat a balance dysfxn in a high level of motor fxn patient
- does not dx the cause of the balance dysfxn
- pass/ fail different coordination activities
- each leg is tested twice, each condition 5x for how long the position is maintained and how many steps it takes to recover
When would you use the fugl - myer outcome?
assess balance in patients with hemiplegia
- 14 is the best score a patient can get, but does not mean they have normal balance
- 7 items scored on 0-2 scale
- subset of fregly battery intended for hemiplegia
when would you use the functional reach test ?
Assess standing balance and risk of falls
- location of the 3rd MC is recorded (pt makes a fist)
norms depend on age, but 10.5- 17inches in range with lower # for pts over 70 years and higher reach for pts 20 years old
when would you use the rhomburg test
Test balance and ataxia
- 1st test: eyes open, feet together on solid surface
- 2nd test: eyes closed, feet together on solid surface, hold for 30 seconds
- when the vission is taken out, there is a larger somatosensory or vestibular defect causign instability
- if pt cant hold longer than 30 secs its abnormal and sensory ataxia is occurring
How can you further challenge to somatory sensory and vestibular system while testing balance after performig the rhomberg test ?
Sharpened rhomburg
eyes open in tandem stance
eyes closed in tandem stance
How can you differentiate sensory ataxia from cerebellar ataxia ?
rhomburg test results of not being able to stand feet together, eyes closed (+ rhomburg) and presence of ataxia is sensory ataxia
- not cerebellar
When would you use the timed up and go ?
Assess level of mobility and balance
- sit in supported chair, walk 10 feet, must turn around unsupported,reaching or without signs of loss of balance
10 secs- notmal
20- increased risk of falling, limited functional independence
30 secs high risk for fall
when using the scoring scale, 5 is severely abnormal
When would you use the Tinetti ?
assess increased risk for falling,
- transfers , perturbation in standing and gait are assessed
- pt 2 assess gait at normal, and fast (but safe) speeds, and other gait components (step length, height, continuity ect)
- 2 sections; max score of 28 from both, score under 19= high risk for fall
are people more left hemisphere dominant or right?
Most people are right hand dominant and Left hemisphere dominant (95%)
-65% of lefties are left hemisphere dominant too
