By the end of the lecture the student should Understand the Nervous system Understand brain components Understand cranial nerves Understand sensory system Understand DTR Understand UMN and LMN Understand CVA Understand TBI Understand Nervous System Pathologies

The nervous system is made of the central nervous system (CNS) and the peripheral nervous system (PNS).

The central nervous system is made up of the brain and the spinal cord. The peripheral nervous system consists of cranial and spinal nerves The brain controls The brain is made up of four lobes. The spinal cord is a made up of neural tracts that conduct information to and from the

brain. Cranial nerves in the peripheral nervous system connect the brain to the head, neck

and truck. Peripheral nerves allow control of muscle groups in the upper and lower extremities

and sensory stimulation. Homeostasis is a state of equilibrium within tissues. The autonomic nervous system uses neurotransmitters to help conduct nerve signals

and turn on/off various cell groups. Nervous tissue is composed of neurons A neuron includes a cell body, and organelles usually found in cells. Dendrites provide receptive information to the neuron and a single axon carries the

information away. Key Terms

Synapse- junction between two neurons Action potential- threshold at which neurons fire

Frontal lobe-controls emotions, judgments, controls motor aspects of speech, primary motor cortex for voluntary muscle activation

Parietal lobe-receives fibers with sensory information about touch, proprioception, temperature, and pain from the other side of the body

Temporal lobe-responsible for auditory information, and language comprehension Occipital lobe- center for visual information Cerebellum- coordination of muscle function Brainstem - (midbrain, pons, and medulla)-respiratory and cardiac center, nerve pathways to the brain Diencephalon – (thalamus, subthalamus, and hypothalamus) Thalamus – Integrate and relay sensory information from the face, retina, cochlea, and taste receptors. (Interprets sensation of touch, pain and temperature). Hypothalamus 1. Sleeping Cycle 2. Controls the autonomic nervous system and the neuroendocrine systems. 3. Maintains body homeostasis 4. Thirst Center 5. Helps regulate body temperature 6. Helps regulate appetite control 7. Thirst Center 8. Control of Hormone secretion

“Oh Once One Takes The Anatomy Final Very Good Vacations Are Heavenly”

1 Nose 2 Eyes 3,4,6 make my eyes due tricks I-Olfactory-Smell II-Optic-Vision acuity III-Oculomotor – Eye function IV-Trochlear – Eye function V-Trigeminal – Sensory of the face, chewing VI-Abducens – Eye function VII-Facial – Facial expression, wrinkle forehead, taste anterior tongue VIII-Vestibulocochlear – Auditory acuity, balance and postural

responses IX-Glossopharyngeal – taste on posterior 33% of the scale X-Vagus – Cardiac, respiratory reflexes XI-Accessory - Strength of trapezius and Sternocleidomastoid

muscles XII-Hypoglossal – Motor function of the tongue

Light Touch Deep Pain Superficial Pain Vibration Proprioception Kinesthesia Temperature Stereognosis Graphesthesia Two Point discrimination

Facilitation Inhibition

DTR elicit a mm contraction when the mm’s tendon is stimulated.

Grading 0+ 1+ 2+ 3+ 4+DTR C5-Bicep C6-Brachioradialis C7-Tricep L4-Patellar Tendon S1-Achilles Tendon

Upper Motor Neuron Lesion A. Disuse atrophy B. +Babinski C. Hypertonia (Spasticity) D. Weakness/paralysis of movement E. HyperreflexiaLower Motor Neuron Lesion A. True Atrophy B. Weakness of individual muscles C. Fibrillations D. Hyporeflexia

Anterior cerebral stroke lower extremity more involved than upper

extremity, contralateral hemiparesis and sensory deficits

Posterior cerebral stroke contralateral sensory loss, transient

contralateral hemiparesisMiddle cerebral artery stroke upper extremity more involved than the

lower extremity, contralateral sensory loss

UE Flexor Synergy Extensor SynergyLE Flexor Synergy Extensor SynergyAneurysm Precautions 1. Avoid rectal temperatures 2. Limit visitors 3. Avoid Valsalva’s maneuver 4. Head of bed should be between 30-45 degrees

No voluntary movement, Initial flaccidity and no tone noted.

Onset of hyperreflexia, synergies and spasticity

Movement in synergy Decrease in synergy, some voluntary motor

control Progressing improvement with voluntary

motor control Patient has returned to semi-normal state-

near normal

Glascow Coma Scale +Eye Opening +Best Motor Response +Best Verbal ResponseLevel of Consciousness Coma Stupor Obtundity Delirium Clouding of Consciousness Consciousness

I. No responseII. Generalized ResponseIII. Localized ResponseIV. Confused-AgitatedV. Confused-InappropriateVI. Confused-AppropriateVII. Automatic-Appropriate

Sympathetic (Fight or Flight): 1. Dilated pupils 2. Elevates heart rate and respiratory rate 3. Sweating 4. Epinephrine and norepinephrine secreted 5. Increased blood pressure 6. Constriction of skin and abdominal arteriolesParasympathetic: 1. Constricted pupils 2. Lowers heart rate and respiratory rate 3. Increased peristalsis 4. Acetylcholine secreted 5. Decreases blood pressure 6. Relaxation of skin and abdominal arterioles

Valsalva’s maneuver –causes an increase in intrathoracic pressure with an accompanying collapse of the vein of the chest wall. The following may result: 1. Decreased return of blood to the heart 2. Slowing of the pulse 3. Elevated intrathoracic pressureHorner’s Syndrome- A lesion in the brain stem that causes disrupted sympathetic innervation to the face and causes: no sweating, ptosis and papillary

constriction.Autonomic Dysreflexia- caused by a lesion in the high thoracic or cervical cord. Severe hypertension, sweating and headaches noted. May occur with a

blockage in a urinecatheter. Signs/Symptoms 1. Bradycardia 2. Headache 3. Increased parasympathetic activity 4. Excessive perspiration 5. Excessive sympathetic response 6. Elevated blood pressure 7. Stimulation of baroreceptors in aortic arch and caroticd sinusParkinson’s Disease-a degenerative disease with primary involvement of the basal ganglia; characterized by the following: Signs/Symptoms 1. Bradykinesia 2. Resting tremor 3. Impaired postural reflexes 4. Rigidity 5. Loss of inhibitory dopamine 6. Mask like affect 7. Emotional liabilityPost-polio Syndrome- slowly progressive muscle weakness disease Sign/Symptoms 1. Onset of muscle Weakness 2. Pain/Myalgia 3. High levels of fatigue

Multiple Sclerosis–progressive demyelinating disease of the central nervous system affecting mostly young adults and is chronic. Cause unknown, most likely viral. 1. Fluctuating exacerbations 2. Demyelinating lesions limit neural transmission 3. Confirmed with lumbar puncture, elevated gamma globulin, CT/MRI, myelogram, EEG. 4. Mild to moderate impaired cognition common 5. Sensory Deficits 6. Bowel and Bladder Deficits 7. Spasticity common 8. Ataxic gaitMyasthenia gravis- neuromuscular disease characterized by fatigue of skeletal muscles and muscular weakness. Signs/Symptoms 1. Progressive involvement 2. Decreased muscle membrane acetylcholine receptors 3. Severe weakness (proximal more than distal muscles) 4. Facial, ocular and bulbar weakness 5. Possible life-threatening respiratory muscle weakness 6. Probable use of anticholinesterase drugs for treatmentGuillain-Barre’ Syndrome-polyneuropathy with progressive muscular weakness Signs/Symptoms 1. Demyelination of peripheral and cranial nerves 2. Motor paralysis in an ascending pattern 3. 3% Mortality – respiratory failure 4. Autonomic dysfunction-arrhythmias, blood pressure changes, tachycardiaAmyotrophic lateral sclerosis (Lou Gehrig’s disease) – degenerative disease that affects anterior horn cells and corticospinal tracts. Signs/Symptoms 1. Death typically in 2-5 yrs. 2. Spasticity, hyperreflexia 3. Dysarthria, Dysphagia 4. Autonomic Dysfunction in approximately 1/3 of patients 5. Cognition is normal

Seizures Epilepsy-recurrent seizures due to excessive and sudden discharge of cerebral

cortical neurons. Tonic-clonic (Grand Mal) –Pt. confused and drowsy about the seizures, 2-5 min

generally Absence seizures (Petit Mal)- Brief, no convulsive contractions, may be up to 100X

day Simple Seizures- no loss of consciousness Complex Seizures, brief loss of consciousness with psychomotor changesWhen a patient has a seizure do not use a tongue blade and allow free movement in a safe environmentMeningitis-inflammation of the meninges of the spinal cord and brain caused by

bacteria.Signs/Symptoms 1. Brudzinski’s sign 2. Kernig’s sign 3. Stiff/Tight neck 4. Fever 5. Confused

FSBPT. “2010 NPTE Candidate Handbook.“ 2010. 1-43. Print.

Morrison Media LLC. “NPTAE Secrets.” 2008. 1-171. Print.

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