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Physiotherpy > The Spinal Cord and Pain > Flashcards

The Spinal Cord and Pain Flashcards

1
Q

What are the two tracts that are located in the Spinal cord?
What do they do?

A

An Ascending Sensory Tract - carrier information up to the brain from the spinal cord.

A Descending Motor Tract - carrier information down from the brain to the spinal cord.

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2
Q

Describe the sensory information and name it’s 3 main tracts.

A

Sensory info goes up to the sensory cortex in the front parietal lobe.
Dorsal column
Spinothalamic
Spinocerebellar

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3
Q

Describe the motor information and name it’s 4 main tracts.

A 
Goes from the motor cortex in the back of the frontal lobe and descends to the spinal cord.
Corticospinal
Vestibulospinal 
Rubospinal 
Resticulospinal
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4
Q

Describe the dorsal column

A

Found on the dorsal white matter

Two sections - Gracilis and Cuneatus

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5
Q

What information does the dorsal column carry?

A

Touch sensation, joint sensation and vibration sensation.

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6
Q

Where does the gracilis and cuneatus bring information from?

A

Gracilis - from the lower limb and trunk

Cuneatus - from upper limb and upper chest

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7
Q

Describe the order of impulse from spine to brain in the Dorsal column

A

First order neurone brings signs, from receptor
Will then synapse with a second order neurone at the gracile or cuneate nucleus
Second order neurone cross contra-laterally at the Medulla and travels to the Thalamus
Synapses with a third order neurone at the thalamus
Info travels to the primary sensory cortex in the parietal lobe

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8
Q

Describe the Spinocerebella tract. What are it’s two tracts?

A

Runs from the spinal cord to the cerebellum
Split into
Posterior spinocerebella tract
Anterior spinocerebella tract

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9
Q

What information does the spinocerebella tract transmit?

A

Transmits information about body position and understanding where it is in a space
Transmits balance and coordination information

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10
Q

What is the oath of the anterior and posterior spinocerebella tracts?

A

PST - uncrossed Tracy that enters the cerebellum via the inferior cerebellum tract

AST - where most fibres cross the spinal cord at level of entry and then cross back just before entering the cerebellum via the superior cerebellar peduncle

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11
Q

Describe the Corticospinal tract. What are it’s 2 tracts spilt into?

A

Originates in the motor cortex and travels down directly to the spinal cord
Split into;
Lateral corticospinal tract
Anterior corticospinal tract

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12
Q

What do the lateral and anterior corticospinal tracts carry?

A

LCT - carries information essential for control of the extremities

ACT - carries information essential for control of the axial skeleton

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13
Q

What is the route of the corticospinal tract?

A

Originates in the motor and pre motor area of the cortex
Axon descends ipsilaterally via the cerebral, peduncle and converge into axon bundles at the Medulla oblongata
Here the tract emerges into two
- 80-90% of the fibres cross to the contra-lateral side and descend as the LCT to the correct area of the spine. Involved with fine motor movements.
- other 10-20% descend as the ACT and cross over at the respective spinal cord level.

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14
Q

Describe the reticulospinal tract

A

Indirect tract
Originates from the reticular formation in the brain stem - connects a lot of the nerve networks together
Travels down the Spinal cord
There is a lateral and medial reticulospinal tract but it’s difficult to identify
Lateral - facilitates flexor movements and inhibits extensors movements.
Medial - facilitates extensor movements and inhibits flexor movements.

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15
Q

Describe the Vestibulospinal tract

A

Originates from the lateral vestibular nucleus located in the brain stem and ends in the spinal cord
Integration between the head and the neck, axial skeleton and extremities and controlled by the activity in this tract
An uncrossed tract
Involved in reflexes and balance

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16
Q

Describe the Rubrospinal Tract

A

Originates from the red nucleus in the brain stem and ends in the spinal cord
Helps with fine, precise motor control movements
A crossed tract
Unsure if it is evident in humans

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17
Q

What can a spinal cord lesion cause?

A

Impair motor, sensory and autonomic function.

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18
Q

What percentage of lesions are traumatic? What can cause them?

A

84%

Car accidents, diving, rugby, domestic, accidents at work

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19
Q

What percent of lesions are non-traumatic? What’s caused them?

A 
16%
Spinal infection 
Tumour
Inflammation 
Viral infection 
Abnormalities
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20
Q

What are some vulnerable areas of the spine?

A

Cervical spine - C5-7, 55% of injuries occur here
Thoracolumbar - T12
Mid thoracic - T4-7

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21
Q

What occurs with a complete spinal cord lesion?

A

Complete loss of function below injury point
Outcome predictable
No sensory or motor information up or down

22
Q

What occurs with an incomplete spinal cord lesion?

A

Some sparring of neural activity below the level of the lesion
More common
Outcome less predictable

23
Q

What is Tetraplegia?

A

Impairment or loss of motor function and or sensory function in cervical segments of the cord.
Affects all four limbs

24
Q

What is paraplegia?

A

Impairment and loss of motor function and or sensory function in the thoracic, lumbar or sacral segments of the cord.

25
Q

Define pain

A

An unpleasant sensory or emotional experience

Associated with actual or potential tissue damage

26
Q

What are the two types of sensory receptor categories?

What information do they detect?

A

Special senses - vision, hearing, balance, taste, smell

Sanatorium senses - touch, pressure, vibration, thermal, proprioception

27
Q

What are the 3 types of nerve fibres that transmit sensory information?

A

A delta
C fibres
A beta

28
Q

Describe A delta fibres

A 
A nociceptor 
Lightly myelinated 
Small in diameter
Respond to chemical and thermal stimuli 
Carry rapid and sharp pain
Initial reflex response to acute pain
29
Q

Describe C fibres

A 
A nociceptor 
Unmyelinated 
Smaller type of nerve fibre
Slowest conduction
Respond to thermal, chemical and mechanical stimuli 
Slow burning pain produced
30
Q

Describe A beta fibres

A 
Mechanoreceptors 
Highly myelinated 
Large diameter 
Rapid signal conduction 
Low activation threshold 
Respond to light touch 
Produce non painful information
31
Q

What are the two ascending pain pathways?

A

Spinothalamic tract

Spinoreticular tract

32
Q

Describe the spinothalamic tract

A

Carry’s main pain signals
Info from the dorsal horn via the second order neurone to the thalamus.
The onto the sensory cortex via the third order neurone

33
Q

Describe the spinoreticular tract

A

Close to the spinothalamic tract
Ascends to a reticular formation then to the thalamus
Terminates via the third order neurone at the sensory cortex
Role in memory and emotional pain

34
Q

What is the role of the descending pain pathway?

A

To control and inhibit the messages sent along the ascending pathway.

35
Q

What is the descending path way called?

A

Periaqeductal grey

36
Q

How does the brain process pain?

A

Receives information
Processes the info
Executes and appropriate response

37
Q

What does the speed of the impulse to the brain depend on?

A

Severity and types of pain

38
Q

What occurs when lain reaches the sensory cortex?

A

Where the pain sensation is experienced
Reacts to the pain message by locating the source of pain and assessing the damage
Determines a course of action
Also communicates to the body’s automatic system - which directs more blood flow to the area to try and fix any tissue damage
Transmits pain suppressing signal, stopping messages travelling through the spinal cord.

39
Q

What role does the Limbic system play?

A

It’s affected by whether pain is more or less intense

Deals with the emotional side, such as experiencing anxiety, fear and frustration

40
Q

What do we have in addition to these pathways, due to some instances not having enough time to transfer the messages to the brain?

A

Reflexes

41
Q

What occurs at a reflex arc?

A

Sensory neurone is stimulated
Message sent along first order neurone
Instead on transmission to second order neurone it passes in an interneuron
Allows the impulse to bypass the second order neurone and brain and Exeter the anterior horn of the spinal cord
Response transmitted directly back to the limb

42
Q

What is the pain gate theory?

A

Uses the concepts of gates which are located between peripheral nerves and the spinal cord up to the brain.
Describes how some pain messages are allowed to get through and reach the brain and others are blocked, inhibited.

43
Q

What factors can affect the Pain gate?

A

State of mind
Endorphins
Central control

44
Q

Describe state of mind

A

The substantia gelatinosus is affected at the pain gate
E.g. anxiety will cause more impulses from the brain and open the gate, which increases pain perception
Relaxed will close the gate.

45
Q

Describe endorphins affecting pain

A

The messages reaching the brain cause impulses to be sent to release endorphins from the posterior horn
This closes the pain gate
Levels of chemicals can also be raised by exercise and trauma

46
Q

Describe the central control affect

A

Brain can open or close the gate in response to memories, last experiences and previous response strategies

47
Q

What are the different types of pain?

A 
Acute 
Chronic 
Nociceptor 
Neuropathic 
Psychogenic
48
Q

Describe acute pain

A

Lasts for less than three months

49
Q

Describe chronic pain

A

Persistent pain, for more than 3 months
Due to a dysfunctional nociceptive system
Or due to ongoing tissue damage such as arthritis
2 types:
Peripheral sensitisation - increase in sensitivity to an afferent nerve stimulus
Central sensitisation - feeling of pain in areas with no pathology due to the central nervous system going through a process known as ‘wind up’
Wind up is where the system is regulated in to a persistent state of high reactivity.

50
Q

Describe nociceptor pain

A

Caused by stimulation of nocioceptors in soft tissue

51
Q

Describe neuropathic pain

A 
Caused by damage to the Nervous system 
Burning pain and altered sensation 
Caused from disorders of the peripheral and central nervous system 
- Peripheral neuropathic pain 
- Central neuropathic pain
52
Q

Describe psychogenic pain

A

Pain affected by emotional and psychological factors

Physiotherpy (7 decks)

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