NEUROANATOMY AND NEUROPHYSIOLOGY FOR PHYSIOTHERAPISTS In order for physiotherapists to provide effective rehabilitation it is imperative that we have a detailed understanding of the anatomy and physiology of both the central and peripheral nervous systems. As physiotherapists we are primarily concerned with the neuro-anatomy and physiology responsible for the sensory and motor control of movement. It is also very important that we have a good understanding of the impact of cognitive and perceptual factors upon an individual’s abilities to function. The following worksheets have been designed as a guide for you and are by no means exhaustive. We would recommend the text by Michael-Titus et al (2010) if you would like to explore this in more depth. You may find a text such as Marieb’s (2016) Human Anatomy and Physiology 10 th Ed to be a good place to start with basics. Additionally there is a specific internet resource for Basal ganglia. There are also some recorded lectures to support your learning, so please view these, especially for the more tricky parts. Part 1 introduces the overall gross anatomy . Part 2 looks more closely at the level of neural function. This will help you to understand later concepts such as inhibition, disinhibition and plasticity. document.docx
Transcript
NEUROANATOMY AND NEUROPHYSIOLOGY FOR PHYSIOTHERAPISTS
In order for physiotherapists to provide effective rehabilitation it is imperative that we have a detailed understanding of the anatomy and physiology of both the central and peripheral nervous systems. As physiotherapists we are primarily concerned with the neuro-anatomy and physiology responsible for the sensory and motor control of movement. It is also very important that we have a good understanding of the impact of cognitive and perceptual factors upon an individual’s abilities to function.
The following worksheets have been designed as a guide for you and are by no means exhaustive. We would recommend the text by Michael-Titus et al (2010) if you would like to explore this in more depth. You may find a text such as Marieb’s (2016) Human Anatomy and Physiology 10th Ed to be a good place to start with basics. Additionally there is a specific internet resource for Basal ganglia. There are also some recorded lectures to support your learning, so please view these, especially for the more tricky parts.
Part 1 introduces the overall gross anatomy .
Part 2 looks more closely at the level of neural function. This will help you to understand later concepts such as inhibition, disinhibition and plasticity.
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Part 1 Nervous System OverviewLearning Objectives
On completion of these worksheets you should be able to:
Identify the main structures of the brain, spinal cord, cerebellum and basal ganglia in relation to movement control
Identify structures which protect the central nervous system
Identify the ascending and descending tracts of the CNS and state their role in movement control.
Discuss the roles of the homunculi and motor control areas in movement control.
Describe reflex arcs and discuss their role in normal and abnormal movement.
Identify the basic structures of the cerebellum and discuss the functions of these structures in movement control
Identify the basic structures of the basal ganglia and discuss the functions of these structures in movement control
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The Central Nervous System
In the table below write the structure and a few lines on its general function.
Structure FunctionFRONTAL LOBE
PARIETAL LOBE
OCCIPITAL LOBE
CERBELLUM
TEMPORAL LOBE
BRAIN STEM
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Protecting the CNSIdentify the mechanisms the following protective features use to ensure the CNS is not compromised.
Meninges
Cerebrospinal Fluid
Blood Brain Barrier
Circle of Willis
Structure Protective MechanismMeninges What are they?
Mechanism
Cerebrospinal Fluid (CSF) What is it?
Mechanism
Blood Brain Barrier (BBB) What is it?
Mechanism
Circle of Willis What is it?
Mechanism
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Getting Information into and out of the Brain: Tracts
The nervous system converts sensory information from the periphery into electrical impulses (see later) These impulses are carried to the spinal cord and then brain for processing. Outputs from the brain are sent to muscles via alpha-motorneurons.
We have specialized routes in the spinal cord and brain stem to carry all this information. These are the tracts. Sensory tracts Ascend, Motor Tracts Descend. Watch the video lecture on tracts.
What does afferent and efferent mean?
Which of the tracts are afferent? Why does this make sense?
Where are the sensory tracts for the sense of proprioception for the lower limbs found?
What is decussation?
Identify where the different sensory and motor tracts decussate.
If we were going to do the Time Warp (watch the video clip!) which tract helps us jump to the left, and which helps with the pelvic thrust?
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Homunculi and Motor Areas
The homunculus is a somatotopic map represented on the surface of the brain
What is noticeable about the proportions of the body as represented on this map for the sensory and motor homunculus?
In which lobe are the pre-motor and motor cortices located?
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Reflexes
There are many times when movement is controlled or occurs without conscious control. This is reflex activity and we have a few key spinal reflexes. It is important that you understand these mechanisms as it has implications when we look at abnormal muscle tone and movement.
What is the purpose of these spinal reflexes?
Stretch Reflex
Identify the main neurons involved in a simple stretch reflex (e.g. the patellar tendon tap).
What effect does stretch reflex have on the muscle involved?
What is reciprocal inhibition and why is it important?
What is the crossed extensor reflex? Why is it important?
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CerebellumCerebellum Function and CircuitryThe cerebellum assists us with the execution of appropriate movements. Answer the following questions about the function of the cerebellum and its function
What is meant by actual versus intended movement?
What types or aspects of movement do we need to regulate to maintain appropriate motor function?
Where does the cerebellum get its inputs from? Where does it send its outputs?
What are cerebellar peduncles and where are they located.
Specific Cerebellar StructuresThe cerebellum is arranges so that specific structures deal with different aspects of movement. Watch the lecture on Cerebellum. Sketch and label a diagram of the cerebellum. Use the following guidelines to help you with your diagram.
Name the 3 main areas of the cerebellum.
Identify if you think they monitor actual or intended movement.
State where they send their outputs
Identify the functions of the 3 main areas
Identify the movement errors you would see if these areas were damaged. Match the movement errors to the areas of the cerebellum you have identified.
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Basal Ganglia
The basal ganglia is the name of a collection of nuclei and stuctures which link together to drive movement. Use the associated reading to support your work.
What is the very basic function of the basal ganglia in voluntary movement?
Which four neurotransmitters are key to the functioning of the Basal Ganglia?
What is meant by disinhibition in a neurological context.
How does disinhibition affect the function of the basal ganglia?
What are the two common neurological disorders that are as a result of basal ganglia dysfunction?
What are the movement differences in the overt clinical manifestations of these conditions?
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Part 2: Neuron Function
Learning Objectives
On completion of these worksheets you should be able to:
Identify the basic structure of a simple neuron, name the component parts and describe their functions.
Describe how an action potential is conducted along a neuron
Explain the physiology of the phases of an action potential
Describe release of neurotransmitters at a synapse [neuron:neuron or neuromuscular junction]
Explain what is meant by depolarization, repolarisation and hyperpolarisation.
Use the words below to label the diagram of a simple neuron.Dendrite Nucleus Node of RanvierMyelin sheath Axon Cell bodyAxon terminals Schwann Cell Axon hillock
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Synapses and Neurotransmitters:Communication between Neurons
Below is a diagram of a typical chemical synapse. Vesicles containing neurotransmitter are shown.
Complete the paragraph below using the words at the bottom of the page. Each word is used only once.
Synapses allow information to be filtered and intergrated. Clients with psychiatric disorders, or
neurodegerative diseases may experience alterations in the functioning of synapses that disrupt
passage of information. This may affect their motor or learning skills.
The neuron passing on the information at the synapse is the ___________________________ neuron. This neuron is separated from the __________________________ neuron or, if it is a nerve-muscle
synapse a neuromuscular junction [NMJ] by the __________________ ________. Nerve impulses
cannot cross this gap. A specific chemical called a _______________________ is required. Examples
of these chemicals are acetylcholine and noradrenaline (norepinephrine). The neurotransmitters are
stored in the presynaptic neuron in secretory _____________ that release the chemicals in response
to _____________ ____________________ reaching the synaptic end bulb. The release of
neurotransmitter depends of influx of _______ ions through ion channels. The neurotransmitter
crosses the gap by the process of ___________. Located in the postsynaptic membrane, there are
protein molecules called _______________. The neurotransmitter binds to the protein. This binding
of neurotransmitter to protein causes the opening of ion channels in the protein. When these
channels open they allow the influx of ____________ ions to initiate the next series of depolarisations
and action potenitals in the post-synaptic neuron. This transfer of chemical information is
Below is a diagram of a trace recorded from a neuron.
Read the text below, and use the words in BOLD to correctly label the diagram.
An action potential [impulse] occurs when a neuron is stimulated above its resting potential. This potential is measured at –70 mV. The neuron must be stimulated to –55 mV, the threshold potential to achieve depolarisation of the membrane. A stimulus to a neurone causes fast sodium voltage-gated ion channels to open. Sodium ions rush into the neuron cytoplasm. This Na+ influx pushes the membrane potential through 0 mV, and up to around +30 mV. This is called depolarisation. Slow voltage-gated potassium channels open, and allow K+ ions to diffuse out of the cell. This is the repolarisation phase of the action potential. This K+ efflux continues until the potential falls below the resting potential. This is called hyperpolarisation, where the membrane is even more negatively charged. The resting membrane potential is restored by sodium-potassium pumps.
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