Week 13 Cue Cards

autonomic nervous system (ANS)

Definition of the Autonomic Nervous System

• Network managing unconscious tasks such as:

  • Heartbeat.

  • Breathing.

• Divided into two main divisions:

1.          Sympathetic Nervous System

2.          Parasympathetic Nervous System

sympathetic nervous system (SNS)

• Function: Prepares the body for physical activity, often labelled the "fight or flight" response.

  • Activated during stressful situations.

  • Characteristics include:

  • Increased heart rate.

  • Increased blood pressure.

  • Increased breathing rate.

  • Reduced digestion.

  • Dilation of pupils.

  • Blood redirected to muscles, preparing for rapid action.

• Examples of activation:

  • Running away from danger or an approaching bus, causing an adrenaline response.

parasympathetic nervous system (PNS)

• Function: Promotes "rest and digest" activities, counteracting the SNS effects.

  • Conserves energy and regulates body functions at rest.

  • Characteristics include:

  • Slowing heart rate.

  • Stimulating digestion.

  • Constricting pupils for close-up vision.

• Importance: Essential for relaxation and maintaining homeostasis, enhancing overall well-being.

brain control centres for autonomic functions

• Major Central Nervous System centres controlling SNS and PNS behaviours include:

  • Hypothalamus: Vital for interpreting signals and initiating responses.

  • Amygdala, Hippocampus, Insula: Involved in emotional responses, memories, and integration of sensory inputs.

• Process of Processing Information:

  • Contextual information from the cerebral cortex and sensory inputs is interpreted by the hypothalamus, leading to orchestrated visceral and somatic motor responses.

cholinergic system and neurotransmitters

• Neurotransmitters facilitate the balance between SNS and PNS.

• In SNS activation, physiological responses include:

  • Vasodilation and vasoconstriction.

  • Activation of piloerection (hair standing up along the arms due to nervous response).

clinical implications for autonomic responses

• Understanding client states:

  • Identifying Sympathetic Activation: Requires strategies to calm, such as:

  • Reducing environmental stimuli.

  • Using calming tones during interaction.

  • Lowering room lights when appropriate.

  • Identifying Parasympathetic Activation: May require stimulating environments to enhance engagement.

importance of hydration and fluid control 

• Hydration supports fluid balance within body compartments:

  • Intracellular (2/3 of body water): Includes cytoplasmic fluid.

  • Extracellular: Divided into:

  • Intravascular (blood plasma)

  • Cerebrospinal fluid.

  • Interstitial fluid.

• Maintenance of water levels is crucial; excess dehydration or volume deficits prompt thirst.

thirst mechanism

• Thirst can be classified into:

  1. Osmometric Thirst:

• Triggered by increases in osmotic pressure (difference in solute concentrations between bodily fluids).

• Primary detection by anterior cingulate cortex and hypothalamus.

4. Volumetric Thirst:

• Resulting from fluid loss (e.g., blood loss, vomiting).

• Detected by receptors in kidneys and heart.

Implications vary based on physical activity levels:

• Active individuals require higher fluid intakes, while sedentary persons may require less.

importance of eating

• Eating provides:

  • Energy for bodily functions.

  • Essential nutrients for biological processes.

• Eating behaviour regulation involves complex factors:

  • Appetite Control: Influenced by:

  • Cultural norms (e.g., meal times).

  • Environmental factors and bodily signals (e.g., hormonal secretions).

  • Hunger Regulation:

  • Involves metabolic signals from the body indicating energy depletion (e.g., hypoglycaemia).

mechanisms of eating behaviour

• Two primary signals for eating:

  1. Hunger Signals: Generated by cultural upbringing and biological needs (e.g., body’s timing mechanisms).

  2. Satiation Signals: Triggered by nutrient absorption leading to hormonal responses, notifying fullness.

measuring sleep

• Sleep is assessed through EEG monitoring to track:

  • Brain wave patterns corresponding to sleep stages and alertness.

• EEG Wave Types:

  • Alpha Waves: Medium-frequency (8-12 Hz); indicate relaxation and transition to sleep.

  • Beta Waves: Higher-frequency (14-30 Hz); associated with cognitive alertness and activity.

sleep cycles

• Typical sleep cycle spans roughly 90 minutes and includes important stages:

  • Transition from light sleep through deep sleep to REM sleep.

  • Cycles recurred multiple times throughout an 8-hour sleep period.

• Importance of REM Sleep:

  • Vital for memory consolidation, learning, and overall brain recovery.

sleep requirements by age

• Recommended sleep durations across various age groups:

  • Newborns (0-3 months): 14-17 hours.

  • Infants (4-11 months): 12-15 hours.

  • Toddlers (1-3 years): 12-14 hours.

  • Children (6-13 years): 9-11 hours.

  • Teens (14-17 years): 8-10 hours.

  • Adults (18+): 7-9 hours.

clinical implications of sleep hygiene

• Importance of assessing client sleep patterns for rehabilitation success.

• Poor sleep impacts:

  • Pain perception.

  • Coping behaviours.

  • Neuroplasticity and learning capabilities.

• Encourage improvements in sleep habits:

  • Advocate for a suitable sleep environment (e.g., dark, quiet).

  • Suggest techniques like earplugs, temperature control, and effective evening routines.

  • Education on managing technology use before bed to enhance sleep quality.

nutritional timing

• Timing of food intake affects physiological states:

  • Eating too close to bedtime can disrupt sleep quality.

  • Recommendation to have a fasting phase before sleep begins (e.g., no food after 6 PM if bed is at 10 PM).

association cortices

• Outer part of the cerebral surface of the brain is referred to as association cortices.

• Major roles in processing sensory and cognitive information.

• Structure: The brain has two hemispheres; each hemisphere processes information from sensory inputs (somatosensory, auditory, visual).

• Information Flow:

  • Perceived at the somatosensory cortex → understood in the parietal cortex → influences from auditory and visual cortices → processed in the frontal cortex where interpretations and responses are generated.

• Example of Reflexive Response:

  • Scenario: Burning one’s hand under hot water.

  • Somatosensory signal indicates danger → parietal cortex for understanding → frontal cortex responds by pulling hand away.

cognition

• Definition: The ability to process and understand external stimuli and make cognitive judgments based on past experiences.

• Importance: Critical for interpreting stimuli and formulating appropriate responses, affecting behaviour and decision-making.

attention

• Mediated primarily in the parietal association cortex; involved in selectively attending to various stimuli.

• Forms of Attention:

  • Selective Attention: Amplifying certain stimuli while diminishing others based on safety and relevance (e.g., not noticing clothing on the body).

  • Attention Disorders: Lesions in the parietal cortex can lead to attention issues, notably neglect syndrome where affected individuals ignore stimuli on one side of the body.

• Example of Neglect Syndrome: Common in right parietal lesions leading to left-side neglect; individuals may not be aware of objects or sounds from that side.

recognition

• Temporal Cortex's Role: Involved in recognising and applying significance to stimuli.

• Areas: Auditory association area in the temporal cortex helps with recognising sounds and speech.

• Facial Recognition:

  • Specific regions involved include the fusiform gyrus and inferior temporal cortex for facial cues.

  • Impact of COVID-19: Masks hindered facial recognition, emphasising reliance on visual feedback and nonverbal cues.

planning and decision making

• Location: Primarily in the frontal association cortex.

• Process: Integrates information from multiple cortices to formulate responses and plans for action.

• Example: A person sitting on a bus processing various sensory inputs to understand their environment and plan movements accordingly.

• Personality Factors: The frontal cortex is key in shaping personality by influencing behaviour control and response inhibition.

memory

• Definition: The process of encoding, storing, and retrieving information.

• Importance: Memory supports cognition and learning by allowing recall of past experiences to influence future actions.

  • Integral to reactions such as pulling away from danger.

types of memory

• Declarative Memory: Memory that can be consciously recalled; organised by factual information, meanings, and history.

• Non-declarative Memory: Procedural skills and emotional responses not easily verbalised (e.g., basketball skills).

• Immediate Memory: Holds information for a very short duration, often less than a minute.

• Working Memory: Used for manipulating information and executing goals, typically lasting seconds to minutes.

• Long-term Memory: Stored for days to years; includes both declarative and non-declarative memories.

memory consolidation

• Long-term memory formation can involve priming through prior encounters, and the significance of associating information for easy recall.

• Notable Facts about Memory:

  • Memory span can vary (often cited as 7±2 items based on cognitive research).

  • Can be improved through techniques like chunking.

  • Conditioned learning examples, such as Pavlov's dog, illustrate associative learning principles.

long-term memory locations

• Declarative Memory: Involving the hippocampus and associated structures.

• Non-declarative Memory: Tied to the cerebellum, basal ganglia, and premotor cortex.

• Importance of specific brain areas in retrieving and processing memory: Wernicke's area for language and object recognition.

forgetting

• Natural process related to information relevance; unused information can lead to synaptic efficiency decline.

• Neuroplasticity enables forgetting for efficiency, termed the "use it or lose it" principle.

• Age-related memory decline can be related to loss of synaptic connections, where brain efficiency is enhanced through activity, including cognitive challenges and physical exercise.

speech and language

• Speech production involves associations of symbols and meanings across various forms (facial expressions, tones, etc.).

• Language processing largely localized in the left hemisphere for structured speech production; the right hemisphere enhances emotional context and rhythm.

• Both hemispheres work together for comprehensive language functions.

emotions

• Emotions are subjective feelings tied to psychological and physiological states, heavily involving the limbic system (amygdala, hippocampus, hypothalamus, thalamus).

• Emotional expressions can be conveyed through facial movements and speech tone, influenced by neurological conditions.

• Conditioning and learned responses can lead to emotional outcomes (e.g., fear of movement due to previous injuries).

sundowning and dementia

·       Sundowning is a common occurrence in people with dementia.

·       It is basically a state of confusion that occurs in the late afternoon and lasts into the night.

·       Sundowning can cause behaviours such as confusion, anxiety, aggression or ignoring directions.

·       At times, sundowning also can lead to pacing or wandering.

tests for sensation

Sharp/blunt (most important)

Light touch

Sensory distinction

Hot/cold (most important)

Discrimination

Consider assessing temp, deep pressure, inattention, texture discrimination, proprioception.

tests for LL weakness

MMT in sitting

30 secs STS or 5xSTS – compare with norms.

functional sit to stands

TUG

assessing postural control 

Observe alignment

Anticipatory, reactive and adaptive postural control

Ankle strategy, hip strategy

Sit to stands

Static postural control assessment

tests for vision

Visual extinction, visual field, visual acuity, smooth pursuit

Left visual loss