Midbrain

Pons

Medulla

L2 -- Conus Medullaris

Below this: cauda equina (nerve roots)

1. White

2. Gray -- "H"/butterfly shaped

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Label

In the ventricles

To: provide cushion and shock absorption

Located: Ventricles

Subarachnoid Space

Spinal Cord

Dura Mater

Arachnoid

(Subarachnoid Space)

Pia Mater

(thickest, most fibrous to thinnest, most delicate)

(outer to inner)

Located on the outside of the brain, continuous with the spinal cord

1. Cerebellum

• Muscle Coordination
• Tone
• Posture

2. Temporal

• Behavior
• Hearing
• Language Reception/Understanding

3. Frontal

• Personality
• Motor Movement
• Expressive Speech

4. Parietal

• Gross Sensation (touch/pressure)
• Fine Sensation (texture, weight, size, shape)
• Reading Skills

5. Occipital

• Vision
• Recognition of size, shape, color

• Thalamus - decides where to send incoming sensory data (fromeyes, ears, mouth, skin)
• Sensory cortex - interprets sensory data
• Hippocampus - stores and retrieves conscious memories; processes sets of stimuli to establish context
• Amygdala - decodes emotions; determines possible threat; stores fear memories
• Hypothalamus - activates "fight or flight" response

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Identify the differences between sensory and motor neurons (physiologically)...

Only when 2+ spinal nerves are involved in the injury can complete anasthesia be possible.

Injury to 1 spinal nerve/level only leads to altered or decreased sensation

They do not form a plexus (join with other nerves).

They maintain segmental relationship.

Anterior Rami: innervate the intercostals

Posterior Rami: innervate the back muscles

Spinal nerves in the cervical region exit the spinal cord .1. the vertebrae, with the exception of .2., which exits .3. .4.

Beginning with .5., nerves come out below the same numbered vertebra.

1. Above

2. C8 nerve

3. Below

4. C7 vertebrae

5. T1 nerve/vertebrae

What is Autonomic Dysreflexia?

- What lesion level is at most risk?

- What triggers it?

- What are the symptoms?

Potentially life threatening --> coma or death

- Injury at/above T10 is at risk, at/above T6 is most susceptible

- Noxious Stimulus below the injury triggers it (ex: distended bladder, bowel impaction)

- Symptoms: severe headache, sudden HTN, facial flush, sweating, gooseflesh

Provides muscles with innervation from more than one level.

In the even of a trauma or disease, perhaps not all levels of innervation will be involved.  Therefore, a muscle may be weakened but not completely paralyzed.

C3 nerve -> Phrenic Nerve -> Diaphragm

When the function of the diaphragm is impacted, independent breathing isn't available.

*Requires assistance for breathing*

Erb's Palsy

- injury to...

- cause 

- presentation

- injury to the brachial plexus

- caused by: 

• The infant's head and neck pulling toward the side as the shoulders pass through the birth canal

• Pulling on the infant's shoulders during a head-first delivery

• Pressure on the baby's raised arms during a breech (feet-first) delivery

   

Burner/Stinger Syndrome

-cause

- caused by a stretch/compression injury to the brachial plexus from a blow to the head or shoulder

-common in football/wrestling

-typically short lived with no residual effects

wrist drop = loss of wrist extension

weakened ability to release objects 

result from high radial nerve injury

often a complication of a midhumeral fracture

Ape hand: loss of thumb opposition 

Caused by a median nerve injury

Results from a loss of the intrinic muscles due to ulnar nerve damage

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Damage to the common peroneal nerve

Can be from cast pressure at the head of the fibula, where the nerve is quite superficial as it lies over the bony fibular head.

Bony: Skull

Membranous: Dura Mater, Arachnoid, Pia Mater

Fluid: Cerebrospinal fluid in the sub arachnoid space

UMN: synapse above the anterior horn of the spinal cord
LMN: synapse at or below the anterior horn of the spinal cord

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Sensory, motor, or mixed impairments

May affect all components of reflex arc

*Most common etiology around absent reflexes

No response

Always abnormal

diminished/depressed response

may or may not be normal

Active normal response

Normal

Brisk/exaggerated response

May or may not be normal

Very brisk/hyperactive; abnormal response

Always abnormal

Temperature

Light touch

Pain

Proprioception

Kinesthesia

Vibration

Bilateral simulataneous stimulation

stereognosis

2 point discrimination

barognosis

localization of touch

Cerebral Palsy

Hydrocephalus

CVA

MS

Huntington's chorea

TBI

Poliomyelitis

Guillain-Barre syndrome

Bell's Palsy

Carpal Tunnel Syndrome

Muscular Dystrophy

tremors are observable at rest and may or maynot disappear with movement

May increase with mental stress

Ex: Pill-rolling tremor (Parkinsons)

Tremors are observable during a voluntary contraction to maintain a posture

Ex: rapid tremor (hyperthyroidism, fatigue, anxiety, benign essential tremor)

AKA kinetic tremor

Tremors are absent at rest, but observable with activity and typically increase as the target approaches

Likely inidcate lesion of the cerebellum

Ex: MS

Sudden, brief, repetitive coordinated movements usually occurring at irregular intervals

Ex: Tourette Syndrome

A form of hyperkinesia

Presents with brief, irregular contractions that are rapid

Typically secondary to damage of the caudate nucleus

Often equated to "fidgeting"

Ex: Huntington's Disease

syndrome of sustained muscle contractions that frequently causes twisting, abnormal postures, and repetitive movements.

Voluntary initiation may -> involuntary contractions

torsion spasms that are continual

patterened and twisting

ex: Parkinsons disease, cerebral palsy, encephalitis

Presents with slow, twisting, and writhing movements that are large in amplitude

Primarily in face, tongue, trunk, and extremities

Common in cerebral palsy secondary to basal ganglia pathology

Inability to initiate movement

(Parkinsons)

Generalized weakness

Typically secondary to cerebellar pathology

Characteristic of an UMN lesion

Involuntary alternating spasmodic contraction of a muscle precipitated by a quick stretch reflex

Change the surface they're standing on

Slopes

Uneven surfaces

Standing on Foam

Eyes Open

Eyes Closed

Vestibular provides CNS w/ feedback of position and mvmnt of head

Movement of head

Berg Balance Scale: score <45/56 = increased risk for falling

Functional Reach Test: Age related standard measurements for good balance

Fugl-Meyer Sensorimotor Assessment: Max score 14; 7 items

Timed Up and Go Test: 10 feet long. Independent if completes in <10s. >20s=increased risk for falls. >30s=high risk for fall

Tinetti: score <19=high risk for fall

An acquired neurological impairment of processing for receptive and/or expressive language

Fluent Aphasia: Functional speech/word output

Empty speech/jargon

Speech lacks substance; use of paraphasis

Non-fluent Aphasia: Poor word output

Impairment of rhythm/inflection of speech

Poor articulation/increased effort for speech

Fluent aphasia

Aka Receptive Aphasia

Impaired comprehension

Impaired writing

Good articulation

Non-Fluent Aphasia

Aka Expressive Aphasia

Most common form of aphasia

Intact auditory/reading comprehension

Frustration w language skill errors

Non Fluent Aphasia

Comprehension severely impaired

May involuntarily verbalize -- w/o correct context

Nonverbal skills for comprehension