12- Physiological Arousal & Emotional Regulation

What are the key components of the physiological arousal response

• Activation of the Sympathetic Nervous System

• Physiological Changes:

• Increased heart rate

• Heightened alertness

• Rapid breathing

• Release of adrenaline and other stress hormones

What is the physiological arousal response?

- Reactions to physical stimuli that are threatening, exciting, or stimulating. Sleep to fight or flight

- Influences emotions and responses to challenges

What are the purposes of physiological arousal response?

Prepares the body for "fight or flight", Enhances survival by enabling quick, decisive actions

What are some situational examples requiring high arousal for optimal performance?

Athletics, driving, paying attention in lecture

What are some examples requiring relatively lower levels of arousal?

Netflix, sleeping

Key function of ANS

Regulates homeostasis!

• Controls bodily functions that occur automatically,

including: Heart rate/circulation, Digestion, Respiratory rate, Blood pressure, Sweating, reproduction

sympathetic nervous system physiological changes

Increases HR, Dilates Pupils, Inhibits Digestion, Increases Respiratory Rate, Release of Stress Hormones

You are treating a patient recovering from ACL repair, working on stability tasks on an unstable surface. What physiological changes would you expect? Would the response hinder or facilitate rehab?

Increases HR, anxiety, heighten level of arousal and focus. Could hinder based on the level of arousal/responsiveness - can't control HR = more movement = less stability while standing

parasympathetic nervous system physiological changes?

decreases HR, stimulates digestion, constricts pupils, promotes energy conservation

You are treating a patient with a total knee replacement, working on knee ROM

• What physiological changes would you expect/promote?

• Would the response hinder or facilitate rehabilitation?

-sleepy, elevated HR, sweating, skin flushing
-hinder

What is the Hypothalamic-Pituitary-Adrenal (HPA) Axis?

Central stress response system (activates about 10 secs after SNS response)

What occurs during HPA?

1) Hypothalamus releases CRH (Corticotropin-Releasing

Hormone).

2) CRH stimulates the anterior pituitary to release ACTH.

3) ACTH signals the adrenal cortex to secrete cortisol.

4) Cortisol mobilizes energy and regulates stress response.

What are the short term effects of cortisol?

Reduces inflammatory responses, increases blood sugar, acute cortisol can be beneficially

What are the long term effects of increased cortisol?

Metabolic issues, issues with gaining and losing weight, diabetes, heart attacks, stroke

High cortisol inhibits CRH and ACTH releases (negative feedback loop). T/F?

True, Body has a harder time shutting down prolonged elevations cortisol levels

What are the physiological effects of cortisol?

• Increases blood sugar level

• Enhances metabolism

• Prolonged and high levels may lead to: Mental health disorders, Cognitive impairment, Metabolic issues (obesity), Suppressed immune response, Hormonal imbalances, GI problems, Chronic pain (fibromyalgia), Cardiovascular problems (HTN)

What is the reticular activating system (RAS)? Where is it located

Primary network that regulates arousal, alertness, and attention levels and is located in the reticular formation (ascending)

descending vs ascending reticular activating system?

Descending: Modifying motor outputs

Ascending: Regulating arousal, alertness, and attention

What are the key functions of RAS?

• Arousal regulation: maintains consciousness and wakefulness; helps regulate the sleep-wake cycle

• Sensory filtering: direct afferents from somatosensory, taste, auditory, vestibular; indirect afferents from olfactory and visual; filters sensory input for selective attention, enhances concentration and cognitive performance

• Sensory integration: integrates sensory input and helps facilitate appropriate responses to environmental changes

• Regulation of autonomic functions, e.g., HR/BP: Interacts with other brain regions involved in autonomic control

• Influences emotions and motivation: connections to limbic system allow it to enhance arousal based on emotion, e.g., increased alertness when fearful

(RAS is more activated during hikes/off trail due to the visual challenges and inconsistent terrain, or walking in an alleyway at night)

MORE ACTIVATED = MORE ALERT/AROUSED

Connections between the RAS, ANS, and HPA Axis influence how the body responds to stress and maintains homeostasis. T/F?

True

RAS and ANS connection

- RAS helps regulate arousal and can influence ANS functions (e.g., HR, BP, RR)

- Activation of RAS can stimulate sympathetic NS, preparing a "fight or flight" response.

- Homeostasis: RAS coordinates with ANS to balance

response to stressors

RAS and HPA Axis connection

-Detects stressors then triggers the HPA axis response

-Elevated cortisol levels: increases alertness and cognitive function

-Hypothalamus is able to reduce the stress response, helping to maintain balance in the body

What is the relationship between arousal and performance?

there's an optical range of alertness and arousal for optimal performance

Simple tasks require lower arousal, complex tasks require higher arousal. T/F?

True

Stress can be adaptive or maladaptive depending on whether situation is approached with a challenge or threat state. T/F?

True

What is challenge state?

-motivated performance, high self-efficacy, high perceived control, approach 
-activation of HPA axis axis dissipates quickly

What is threat state?

-low self-efficacy, low control, avoidance focus

-activation of HPA axis dissipates slowly

How can level of arousal be measured during PT?

- assess pt arousal levels to tailor interventions

- maintain optimal arousal for pt engagement

- use mental prep to enhance confidence

- provide immediate feedback to boost arousal/performance

- address both physical and psychological aspects of rebab

Arousal in the pediatric population

• High energy levels; variable attention spans.

• Use engaging activities; short, varied sessions to maintain interest

Arousal in the geriatric population

• May experience lower arousal levels; higher fatigue

• Incorporate rest periods; monitor for overexertion

Arousal in anxiety disorders

• High baseline arousal; may exhibit avoidance behaviors

• Incorporate relaxation techniques; use gradual exposure to activities

Arousal in athletes

• Optimal arousal is crucial for performance; may experience stress

• Tailor arousal strategies for peak performance; use mental preparation and visualization techniques

Arousal in Neurological disorders

• Arousal can be inconsistent; may require stimulation

• Use sensory input and engaging activities to promote arousal and participation

What are the 5 level of consciousness?

Alert, Lethargic, Obtunded, Stuporous, Comatose

Alert

awake; attentive to normal levels of stimulation

Lethargic

drowsy and may fall asleep if not stimulated in some way; may have difficulty focusing or maintaining attention

Obtunded

difficult to arouse from sleep-state; frequently confused when awake

Stuporous

only responds to strong, generally noxious stimuli; returns to unconscious state when stimuli stopped

Comatose

can’t be aroused, doesn’t respond purposefully to stimulation

Glascow Coma Scale is used to measure:

Level of arousal/consciousness after a brain injury (score range 3-15; <8=poor outcome, 4-8=severe injury, 9-14=mild/moderate injury)

What are the 3 components of the Glascow coma scale?

Eye response, Verbal response, Motor response

What is the limbic system responsible for?

Processing and regulating emotions, motivation, learning, and memory. (Thalamus, hypothalamus, hippocampus, amygdala)

Crucial role in arousal by influence if the body's response to stimuli through connections with the ANS, HPA Axis, and RAS

Amygdala turn on ANS by:

Match input to an internal; representation of threat, threat detector activated (Sees snake, Amy: oh crap a snake, turns on ANS/fight or flight)

Hippocampus function

•Memory formation and emotional context

•Links past experiences to emotional responses

•Associates incoming stimuli with stored representations of learned threats

What occurs with a loss of hippocampus function?

No longer able to encode experiences that are associated with fear/threat - extremely maladaptive

Why is fear stored indelibly?

• If you forget what harmed you in the past your ability to survive is compromised

• Evolution places a high value on not having to re-learn about danger

Fear is stored because it is an adaptive response for survival. I know the stove is hot so I don't touch it any more!

Amygdala function

- Emotion processing

- Activates fight or flight response

- Interacts with the prefrontal cortex for decision making and impulse control

- Interacts with hippocampus to contextualize emotions in memories

Hippocampus vs Amygdala

Hippo: memory about emotion, consciously accessible, conscious thought, conscious memory about the emotion

Amy: emotional memory, consciously in accessible, brain activity and bodily response, unconscious emotional memory

The hippocampus is especially vulnerable to ongoing emotional distress. When the neurons are attacked by cortisol, the hippocampus loses neurons and is reduced in size. T/F?

True

HPA axis commicates via

Hormone only, responding to factors in the blood causing it to be slower

Thalamus function

regulates flow of info to cortex, processes sensory info that can trigger emotional responses

Hypothalamus function

• Maintaining homeostasis

• Eating, reproductive & defensive behaviors

• Emotional expression - pleasure, rage, fear & aversion

• Circadian rhythms

• Growth, metabolism & reproductive organs (endocrine system)

• Activation of the sympathetic nervous system

Initiates stress response!

What is the hypothalamus' connection with ANS and HPA Axis?

Initiates stress response by releasing hormones

Pre-Frontal cortex

allows us to judge, reason, make decisions, plans, process new memories, emotional control

A loss of pre-frontal function causes

Inability to regulate emotions or exert inhibitory control

parasympathetic nervous system is a ____ neuron pathway from the brainstem or sacral spinal cord to _____ organs.

2; Effector