Neurological System

purpose of this system is to coordinate all activities of the body. enablesbody to respond and adapt changes that occur inside and outside the body. split the CNS and PNS.

nervous system

the brain and spinal cord are part of the CNS or PNS?

CNS

part of brain
outer most layer of brain and consists of GRAY matter
- has 2 major hemispheres: right and left, and 4 lobes (frontal, parietal, temporal, and occipital)

cerebrum

the largest of the lobes in the cerebrum

- deals w/ personality, behavior, emotions, and intellectual function
- has Broca's area which controls speech

frontal lobe

if damage occurs to broca's area, you can have a type of aphasia where you are able to comprehend what is being said but you lose the ability to communicate and often sounds like gargled speech

what kind of aphasia?

expressive aphasia

a lobe in the cerebrum

- integrates sensory info
- helps us determine touch, position, vibration, pressure, pain, and temp

parietal lobe

a lobe in the cerebrum

- processes auditory info, taste, and smell that is located behind the ear
- has Wernicke's area which controls language comprehension

temporal lobe

if damage to wernicke's area occurs, this kind of aphasia can occur where you receive the sound but can't comprehend the meaning

what kind of aphasia?

receptive aphasia

a lobe in the cerebrum (back of brain and is the smallest lobe)
- processes visual info

occipital lobe

this helps maintain person's thought, memory, reasoning, sensations, voluntary movement

if damage occurs to any of these areas, person will experience loss of function in that area

cerebral cortex

this area does not initiate movement but helps movement to be coordinated and smooth. damage to this area may lead to jerky movements

- muscle coordination
- help control balance
- help w/ posture
- muscle tone

cerebellum

in the cerebral cortex
this is a cluster of neurons located deep beneath the cerebral cortex
- helps coordinate movement, control, posture
- aids in movement of arm swinging and alternating legs when we are walking
- damage to this causes problems w/ involuntary tremors and delays in excessive movements

basal ganglia

in the cerebral cortex
located between the cerebrum and midbrain

diencephalon

part of the diencephalon

behaves like a relay station
- relay station for sensory impulses to the cerebral cortex
- tied to emotions and creativity

thalamus

part of the diencephalon

- located at base of brain and near the pituitary gland
- regulates temp, water metabolism, appetite, emotional expression, sleep wake cycle, thirst
- coordinates autonomic nervous system function
- helps regulate BP, HR, digestion, and stress response (this is where we get the fight and flight response and rest and digest response_

hypothalamus

part of the brain stem

located below cerebrum
- regulates auditory and visual functions

midbrain

part of the brain stem

lies below midbrain
- helps control respirations

pons

part of brain stem

located at bottom of brainstem. connects to spinal cord
- helps control HR, BP, respirations, swallowing
- crossing of motor fibers occurs here

medulla

continuation of CNS. located centrally within vertebral column. extends from medulla to the level of the 1st lumbar vertebrae. serves as center for conducting sensory and motor message to and from the brain (highway of info)

- occupies upper 2/3 of vertebral canal form medulla to lumbar vertebrae L1 and L2
- helps mediate reflexes (posture control, urination, and pain response)

- cervical, thoracic, and lumbar regions

spinal cord

true or false

the vertebral column continues beyond spinal cord for several inches

this is where the CSF fluid is extracted for sampling and testing when someone gets a spinal tap done

true

where the left cerebral cortex receives sensory info from and controls motor function on the right side of the body
- the right cerebral cortex interacts w/ left side of body
- if you have a right sided stroke you'll have symptoms on the left side

this is an example of ___________

crossed representation

these are the pathways where we have nerves that carry info to the brain (afferent nerves) and we have nerves that carry info to the body (efferent nerves)

sensory pathways

efferent or afferent nerves

nerves that carry info to the brain

afferent

efferent or afferent nerves

nerves that carry info to the body (from CNS to muscles and glands)

efferent

this helps transmit pain and temp. if you hvae an itch, crude touch

spinothalamic tract

helps know body's position within an environment (proprioception). provides info about the sense of vibration. being able to identify a specific or familiar object (finely localized touch)

posterior (dorsal) column

consist of specific motor fibers within the areas of the brain that control movement and travel to the brainstem

motor pathways

- involved w/ skilled purposeful movements
- coordinates fine motor movements esp in hands such as writing

corticospinal or pyramidal tract

- involves primitive motor movements like walking
- maintains muscle tone and body control

extrapyramidal tract

coordinates movement, maintains balance, and equilibrium, posture
- receives info about our body's position of propioception
- receives info about our equilbirum and messages are sent to our muscles

cerebellar system

these neurons are completely contained within the CNS. they are initiated from motor areas within the cerebral cortex.
- influences lower motor neuron

upper motor neuron (UMN)

dyfunction to these neurons will result in
- weakness/paralysis
- hyperactive reflexes
- decreased motor control
- abnormal muscle tone
- decreased fine motor movements like writing or typing

upper motor neuron (UMN)

upper or lower motor neuron diseases?
- stroke
- cerebral palsy
- multiple sclerosis

upper

these kinds of neurons are located mostly in PNS
- consists of cranial nerves and spinal nerves of the PNS
- the nerve fiber extends directly into the muscle

lower motor neurons

damage to lower motor neurons usually leads to PERMANENT OR TEMPORARY paralysis

permanent

upper or lower motor neuron diseases?
- bell palsy
- spinal cord lesions
- poliomyelitis

lower

part of the PNS
- rapid involuntary predictable motor response to a stimulus. basic defense mechanism for our nervous system. helps w/ balance and muscle tone

- types include deep tendon (stretch) reflex), superficial (cutaneous reflex), and visceral (organic reflex)

reflexes

these nerves exit the skull
- 12 pairs for each side of the body
- supplies head and neck except cranial nerve X (vagus)- travels to heart, resp, muscles, stomach and gallbladder

cranial nerves

this is part of the PNS and are known as "peripheral nerves"
- exit from spinal cord
- 31 pairs for each side of the body
- named from the area they exit the spinal cord
- 8 cervical spinal nerves
- 12 thoracic spinal nerves
- 5 lumbar spinal nerves
- 5 sacral spinal nerves
- 1 coxyaggeal spinal nerve

each nerve innervates a particular segment of the body
- considered mixed nerves (mix of motor and sensory nerves)

spinal nerves

an area supplied from one spinal cord segment through a particular spinal nerve
ex: when shingles surfaces on the skin you'll only see a rash on one side of the body or dermatome

dermatome

component of PNS and regulates internal environment of the body. supplied by nerve fibres from cranial and spinal nerves

autonomic nervous system

in the autonomic nervous system
- results in skeletal muscle contraction

somatic nerve fibers

in the autonomic nervous system

- regulates our internal organs w/ out conscious effort
- divided into the sympathetic and parasympathetic nervous system

autonomic nerve fibers

sympathetic or parasympathetic nervous system
- fight or flight response- initiated when someone is startled or is faced w/ danger or is in a survival mode mechanism

sympathetic nervous system (SNS)

sympathetic or parasympathetic nervous system

- rest and digest response- conserves our energy. slows heart rate down. increase intestinal and gland activity, relaxes our sphincter muscles in the GI tract

parasympathetic nervous system

neuro system is not completely developed at birth because the neurons are not yet _________

myelinated (myelination is insulation around nerve, helps protect and conduct nerve impulses quickly)

motor activity in newborns is controlled by spinal cord and medulla. it it seen through their __________ reflexes

primitive (reflexes)

the root reflex
the suck reflex
the moro reflex

are examples of what kind of reflexes in newborns

primitive

a primitive reflex

if you stick a bottle near the infants cheek they will turn towards that nipple and start sucking

root (reflex)

a primitive reflex

will begin to suck on that bottle or nipple

suck (reflex)

a primitive reflex

"startle" reflex. when they hear a loud sound or a bump they will get startled

moro reflex

true or false

as cerebral cortex matures and develops during the 1st year the primitive reflexes should diminish after time.

so persistence of primitive reflexes indicates a CNS dysfunctino

true

true or false

sensory and motor development follows a cephalocaudal (head to neck) and proximodistal (trunk to extremities) order to reach developmental milestones in infants

true

this is a "belt" that is 20% higher risk for strokes in the mid south region of the USA

stroke belt

this is a "belt" that is 40% higher risk for strokes in North Carolina, South Carolina, Georgia

food is high in fat, high salt, not sufficient knowledge about risk factors, not sufficient knowledge about symptoms and treatment options available

belt buckle

vertigo or syncope

room is spinning around, usually r/t inner ear or insult to brain stem

vertigo

vertigo or syncope

temporary LOC, r/t cerebral blood flow to the brain (think is their an occlusion or blockage in that vessel causing this episode)

syncope

weakness on one side is associated w/ stroke
true or fale

true

total loss of motor function

paralysis (can be partial or complete)

numbness or tingling is also known as

paresthesia

screening or complete neuro exam?

you don't know if that patient has a problem. you're trying to see if they respond positively meaning they have an issue that has surfaced from your screening

- done on well individuals w/ no significant history

screening exam

screening or complete neuro exam?

exam is completed on someone who has a neuro concern
ex: if patient presents w/ a headache, loss of coordination, if they present w/ confusion, loss of balance, etc

complete neuro exam

order for complete neuro exam (5 components)

Mental Status
Cranial Nerves
Motor System
Sensory System
Reflexes

olfactory nerve is cranial nerve _____

(cranial nerve) I

not tested routinely unless you suspect a frontal head injury
- ask patient to close eyes, occlude one nostril and then test the other nostril. repeat on other side.

cranial nerve I (olfactory)

optic nerve is cranial nerve ______

cranial nerve (II)

what cranial nerve?

- visual acuity- use snellen chart
- visual fields (confrontation test) to test for peripheral vision )

cranial nerve II (optic)

deals with cranial nerve II

this is noted w/ the optic disc for increased intercranial pressure. if you look through the ophthalmoscope in the eye and look through the irisk back to the retina you would see this

papilledema

occulomotor is cranial nerve ________

(cranial nerve) III

trochlear is cranial nerve ______

(cranial nerve) IV

abduences is cranial nerve ______

(cranial nerve) VI

these 3 cranial nerves assess extra ocular movements through the cardinal positions of gaze (diagnostic positions test) and nystagmus or strabismus

- these 3 nerves affect direction of gaze, position of eyelids, and pupil size

(cranial nerve) III
IV
VI

cranial nerve III, IV, or VI

innervates our eyelids to remain open so you would assess for ptosis (drooping eyelids)

(cranial nerve) III

what cranial nerve?

transfers light into neural signal to brain

(cranial nerve) II

what cranial nerve?

sends signal for pupil to react

(cranial nerve) III

trigeminal nerve is cranial nerve ______

(cranial nerve) V

- has a motor and sensory function

- motor: assess jaw strength and movement
- place hand on temporal and masseter muscles. ask patient to clench teeth to assess jaw strength and movement
- muscles should feel firm and strong bilaterally
- if you feel weakness on one side, there is a problem w/ the ______ nerve

cranial nerve V (trigeminal)

- has motor and sensory function

- sensory: asses facial sensation on forehead, cheek, and chin
- ask patient to close eyes and test to see if patient detects facial sensation by using a pin prick or light touch (typically use cotton ball)
- put it on forehead cheek and chin and tell patient to say "now" when they feel the sensation

cranial nerve V (trigeminal)

the facial nerve is cranial nerve________

(cranial nerve) VII

- motor function: assess facial symmetry

ask patient to smile or raise eyebrows. look for symmetry on both sides. eyebrows should raise up equally.
- symmetrical smile- equal amt of teeth on each side
- ask patient to puff out their cheeks and clencth their eyes tight
- when they do this look at the nasolabial fold (prominent when patient puffs out their cheeks)

(cranial nerve) VII

acoustic (vestibulocochlear) is cranial nerve ______

(cranial nerve) VIII

sensory function
- test hearing by acuity
- test by having a normal convo w/ the person. can they hear you okay? are they responding to what you are saying? if not utilize the whispered voice test

(cranial nerve) VIII (acoustic)

glossopharyngeal nerve is cranial nerve ________

(cranial nerve) IX

vagus is cranial nerve _________

(cranial nerve) X

what 2 cranial nerves?

- motor function- palate and uvula elevates midline and tonsillar pillars move medially
- avoid gag reflex
- assess smoothness of voice
- depress tongue w/ tongue blade and ask patient to sayAHHH
- find that the palate and uvula elevate midline and tonsilar pillars move medially (inward)

- sensory function- note presence of pharyngeal sensation
- assess smoothness of voice

(cranial nerves)
IX (glossopharyngeal)
X (vagus)

what cranial nerve supplies sensory info to the palates

(cranial nerve) IX

spinal accessory nerve is cranial nerve __________

(cranial nerve) XI

motor function: examine sternomastoid and trapezius muscles for equal size and strength
- examine and palpate neck and shoulders. assess size of sternomastoid and trapezius muscles
- assess strength by asking patient to shrug their shoulders while you are pushing down
- ask patient to push their face against our hand on their chin

(cranial nerve) XI (spinal accessory)

hypoglossal nerve is cranial nerve _______

(cranial nerve) XII

inspect tongue
- assess speech
- ask patient to stick their tongue out. is it midline or deviated to one side?
- ask patient to move tongue side to side. is it steady?
- ask patient to say light dite and dynamite to assess if speech is clear and distinct

(cranial nerve) XII (Hypoglossal)

a cerebellar function test for coordination and skilled movements

- touch thumb to each finger and then do it in reverse: can they do this in a controlled manner and can they do it fast?
- place hands on thigh and near knee. flip hands back and forth. have patients close eyes; is movement smooth and coordinated?

rapid alternating movements (RAM)

a cerebellar function test for coordination and skilled movements

- w/ the patients eye open, ask patient to alternately touch their nose and examiner's finger as quickly as possible
- after a couple times, examiner will move finger
- assess if movement is smooth and accurate

finger to nose test

a cerebellar function test for coordination and skilled movements
- position patient in a supine position
- take heel and slide down shin to to tip of toe of opposite leg
- it should be a in a straight lin e
- if patient has a problem w/ balance, it won't be a straight light

heel to shin test

a cerebellar function test for balance

how they walk
- ask patient to walk toward you and forward you
- note their stance
- how far apart are their feet?
- how is their posture and stability?
- do they have any leg stiffness or knee bending?
- rate of their walking?
- difficulty initiating walking or stopping

gait

tests cerebellar function test: balance

- walk in straight line walking heel to toe

tandem walking

cerebellar function test for balance

- test for balance
- ask patient to stand w/ feet together
- ask patient to close eyes
- as they hold that position, are they able to hold it for 20 seconds
- if they're having problem w/ gait and balance, be on standby if they start to fall during this test
- detects cerebellum dysfunction
- normally they are able to maintain posture w/ just slight swaying

romberg test

cerebellar function test for balance

- don't do this on patients who will probably fall
- have them stand on one leg w/ other leg bent at knee
- ask patient to do this w/ the leg standing and you're assessing for muscle weakness in hips and thighs

shallow knee bend

when assessing sensory system you should make sure that the patient is alert, cooperative, and comfy so that these tests are valid. you should pick DISTAL OR PROXIMAL locations such as foot, calf, thigh, hands, and forearms. person w/ working peripheral nerve fibers or sensory tracts will be able to identify various types of stimulus

distal

part of the anterolateral (spinothalamic) tract

test patient's perception of pain
- break tongue blade in half to have a sharp edge and dull edge
- ask patient if they can feel sharp or dull
- be sure o pause about 2 seconds before going to another area
-if patient if unable to detect sensation of a specific point or area note in on map or diagram on patient's chart

pain

when testing temperature on a person, is this part of the anterolateral (spinothalamic) tract or the posterior column tract

anterolateral