1
Q
What’s the Circle of Wilis?
A
a ring of nine arteries, which supply all of the blood to the cerebral hemispheres
2
Q
Which artery provides blood to most of the cerebrum?
A
Internal Carotid Arteries
3
Q
Which artery provide blood to the occipital and inferior temporal lobes and to the brainstem/cerebellar region?
A
Vertebral arteries
4
Q
What areas of the brain are supplied by the anterior cerebral artery?
A
medial frontal and parietal lobes
5
Q
What areas of the brain are supplied by the middle cerebral artery?
A
- > globus pallidus, putamen, most of lateral hemisphere, part of internal capsule, and caudate (pg 480, table 25.1)
- > supplies most of the lateral surface of the frontal, parietal, temporal, and occipital lobes
6
Q
Branches of the vertebral arteries and branches of the basilar artery supply the…..?
A
brainstem and the cerebellum
7
Q
Near the junction of the pons and the medulla, the vertebral arteries join to form the
A
basilar artery
8
Q
The basilar artery divides to become the …?
A
posterior cerebral artery (continuing from the Circle of Willis)– the basilar artery and its branches supply the pons and most of the cerebellum
9
Q
What area of the brain is supplied by the posterior cerebral artery?
A
midbrain, the entire occipital lobe, and inferior and medial surfaces of the temporal lobe
10
Q
What area supplied from a branch of the posterior cerebral artery?
A
parts of the thalamus and hypothalamus
11
Q
More than 90% of anterior circulation ischemic strokes affect the?
A
middle cerebral artery (i.e. most commonly injured)
12
Q
the middle cerebral artery provides almost all of the oxygen and nourishment for the?
A
lateral surface of the cerebral hemisphere; occlusion of these branches may affect somatosensory, auditory, motor, and speech activities
13
Q
What lobe is described below?
Frontal/Parietal/Temporal/Occipital/Limbic/Insular?
involved in a wide range of “higher” cognitive functions. It plays a role in everything from movement to intelligence, helps us anticipate the consequences of our actions, and aids in the planning of future actions.
A
Frontal
14
Q
What lobe is described below?
Frontal/Parietal/Temporal/Occipital/Limbic/Insular?
- helps integrate sensory input and process language
- vital for sensory perception and integration, including the management of taste, hearing, sight, touch, and smell. It is home to the brain’s primary sensory area, a region where the brain interprets input from other areas of the body.
A
Parietal
15
Q
What lobe is described below?
Frontal/Parietal/Temporal/Occipital/Limbic/Insular?
- plays a key role in auditory processing.
- This role includes perceiving sounds, assigning meaning to those sounds, and remembering sounds.
- Much of the auditory work of the _____ lobe is processed through the superior temporal gyrus, a ______ lobe structure that receives sound input directly from the ear.
A
temporal
16
Q
What lobe is described below?
Frontal/Parietal/Temporal/Occipital/Limbic/Insular?
is the seat of most of the brain’s visual cortex, allowing you not only to see and process stimuli from the external world, but also to assign meaning to and remember visual perceptions.
A
Occipital
17
Q
What lobe is described below?
Frontal/Parietal/Temporal/Occipital/Limbic/Insular?
- Part of brain region that is vital for the functioning of memory, learning, motivation, and emotion, as well as endocrine functions and some autonomic—automatic, unconscious—bodily functions.
- plays a role in a range of complex emotional reactions.
- One of the most critical roles is in the regulation of endocrine system responses to emotions, such as the adrenaline-based fight-or-flight response.
- Without any voluntary input, the ____ system triggers a reaction to perceived danger. It also regulates both conscious and unconscious functions such as sexual desire, some homeostatic mechanisms, and appetite.
A
Limbic
18
Q
What lobe is described below?
Frontal/Parietal/Temporal/Occipital/Limbic/Insular?
- role in somatic states means that it provides an emotional context for physiological experiences.
- gives meaning to bodily states by, for example, helping you experience pain as unpleasant.
A
Insular
19
Q
The cerebellum function is…?
A
balance
20
Q
The thalamus function is…?
A
proprioception
21
Q
Hippocampus functions ?
A
memory storage/memory facts
22
Q
Basal ganglia is involved in…?
A
social and goal oriented behavior, movement, and emotions
23
Q
Amygdala is involved in…?
A
emotions and motivation
24
Q
Describe CSF
A
- regulates the extracellular milieu and protects the CNS.
- The meninges and buoyancy of the fluid provide protection to the brain by absorbing some of the impact when the head is struck.
25
What is neuroscience?
- Neuroscience is an interdisciplinary science that works closely with other discipline.
- Neuroscientists study the cellular, functional, behavioral, evolutionary, computational, molecular, cellular, and medical aspects of the nervous system.
26
What's “the quest to understand the nervous system.”
Relatively new science concerned with the development, chemistry, structure, function and pathology of the nervous system
27
What type of injuries do you think would benefit from neuroplasticity?
STROKE, CVA
*M.S neuroplasticity would not work. OT can not repair the myelin sheath. M.S gets worse.
28
What is Neuroplasticity?
→ The brain's ability to heal itself. We can not fix all injuries with neuroplasticity. We can not grow new cells with neuroplasticity
29
Purpose of the nine-hole peg test
developed to measure finger dexterity, also known as fine manual dexterity. It can be used with a wide range of populations, including clients with stroke
30
What are spinal nerves?
spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body.
31
How many spinal nerves does the human body have?
- 31 pairs of spinal nerves, one on each side of the vertebral column …
- The spinal nerves are part of the peripheral nervous system.
32
Define Myotomes
a group of muscles derived from one somite and innervated by a single spinal nerve
33
where does the spinal cord ends?
*Distally the spinal cord ends in the conus medullaris.
*the adult spinal cord ends at L1-L2 vertebral level.
the spinal cord splits into two rami this division marks the end of the spinal cord region and the beginning of the PNS. p. 356
34
Describe Anterior cord syndrome
- Caused by disruption of blood flow in the anterior spinal artery.
- Interferes with nociceptive and temperature sensation and with motor control.
- Front part of spinal cord is damaged results in loss of ability to move below the injury.
35
Describe Central cord syndrome:
- Usually occurs at the cervical level as a result of trauma.
- If lesion is small loss of nociceptive and temperature information occurs at the level of the lesion.
- Middle part of SC is damaged results in more loss of movement & sensation in arms than legs
36
Describe Brown-Sequard
- results from a hemisection ½ of the cord.
| - Segmental losses are ipsilateral and include loss of motor neurons and all sensations. (one side of body impacted)
37
Describe Cauda equina syndrome:
- indicates damage to the lumbar and/or sacral spinal roots
| - causing sensory impairment and flaccid paresis or paralysis of lower limb muscles, bladder, and bowels.
38
Describe Tethered cord syndrome:
- The spinal cord becomes attached to surrounding structures during early development.
- Scar tissue, fatty mass (lipoma), or abnormal development can lead to tethering of the spinal cord.
```
Signs include: low back and lower limb pain
Difficulty walking
Excessive lordosis
Scoliosis
Problems with bowel/bladder’
Foot deformities
```
39
Describe autonomic dysreflexia
- medical emergency that can affect people with SCI above T6.
- A noxious stimuli below the level of the spinal cord lesion elicits sympathetic over activity that constricts blood vessels below the level of the lesion, causing an abrupt increase in BP.
40
Describe poor thermoregulation
- common post surgical, inability to control your body temperature.
* may interfere with the ability to maintain homeostasis.
- Interruption of descending sympathetic pathways prevents thermoregulatory sweating below the level of injury.
- People with complete lesions above T6 should AVOID exposure to high temperatures because of risk of heat stroke (signs include:rapid pulse, high body temperature, flushed skin). As well as low temperatures can cause Hypothermia
41
Describe orthostatic hypotension:
* is a 20mm Hg or greater fall in systolic BP or a 10mm Hg or greater fall in diastolic BP on assuming an upright position.
- In people with SCI this is caused by loss of sympathetic vasoconstriction combined with loss of muscle-pumping action for blood return.
* Signs: lightheadedness, dizziness, visible signs include: pallor affecting the UB, sweating, and decreased consciousness.
42
ANS :
| What it is and what it does
- Critical for the survival of the individual and the species because it regulates homeostasis and reproduction.
- ANS maintains homeostasis by regulating the activity of internal organs and vasculature
- ANS regulates circulation, respiration, digestion, metabolism, secretions, body temperature, and reproduction
43
Sympathetic NS
- primary role
- how is the smooth muscles stimulated?
- what does it regulate?
**Example of the Sympathetic NS in action
Primary role: maintain optimal blood supply in the organs
- Moderate activity stimulates smooth muscle in the wall of the blood vessels, maintaining some contraction of the vessel walls
- Regulates body temp; blood flow in skeletal muscle; sympathetic control in the head; regulation of the viscera; and metabolism
**example: fear- when someone feels threatened, the sympathetic NS prepares for vigorous muscle activity (fight or flight)
44
Parasympathetic NS
- Principle function?
- how does info travel?
- When cardiac activity is decrease what occurs in the body?
- Principle function: energy conservation/storage
- Info from the parasympathetic system goes from the brainstem and travels into the cranial nerves to outlying ganglia
- Decreases cardiac activity; facilitates digestion; increases secretions in the lungs, eyes, and mouth; controls convexity of the lens of the eye; constricts the pupil; controls voiding of the bowels and bladder and controls erection of sexual organs
45
Define Syncope
(fainting)
| Brief loss of consciousness due to inadequate blood flow to the brain
46
Describe Vasodepressor syncope (neurogenic shock)
is when the cause of the syncope is caused by powerful emotions (strong emotions can cause sudden, active vasodilation of intramuscular arterioles, causing a precipitous fall in bp)
47
What's Orthostatic hypotension
Decrease of at least 20mm HG systolic bp or 10 mm Hg diastolic pressure during the first 3 mins of standing
48
Sympathetic regulation of the skin can be tested by what 2 test
- sweat test: absorbed by small pieces of filter paper that’s place on the skin and then the filter paper is weighed to determine the amount of sweat
- vasomotor test: skin temp is measured before and after the hands are immersed in cold ware, this test assess the amount of vasoconstriction
49
What does the Valsalva test provides?
rovides information on both sympathetic/ parasympathetic function
-Subject blows into a closed tube that has a small leak for 30 secs. Maintaining 40 mm Hg pressure. Test has 4 phases (TABLE 9-4)
50
what are the 4 phases of the valsalva test?
Phase 1: start: 1 - 3 sec increase blood pressure -> mechanical compression of great vessels
Phase 2: early: systolic and pulse pressure decline-> peripheral venous pressure increases
Late: BP recovery, HR increase -> peripheral sympathetic vasoconstriction; autonomic increase in heart rate/heart contractility
Phase 3: pressure release: 1- 3 sec fall in BP -> release of mechanical compression increases venous return
Phase 4: sustained BP overshoot: increased stroke volume forced into a constricted arterial system causes increase arterial pressure
51
The full somatosensory examination covers these sensations.....
- light touch
- conscious proprioception
- sharp versus dull pain
- discriminative temperature
52
Describe Quick somatosensory testing (screening test)
- consists of testing light touch in the fingers and toes
- testing sharp vs. dull sensation in the same fingers and toes;
**if loss or impairment of sensation is found, then additional testing is performed to determine the precise pattern of sensory loss
53
Describe Light touch: primary sensation
- lightly touch the pad of the patient’s fingertips or toes with a wisp of cotton;
- touch the same area on one side and then the other so that the patient can compare sides
54
What's the purpose of the Ipswich Touch Test (special test)?
he purpose is to identify impaired touch sensation in the feet of people with diabetes
55
Describe Tactile Threshold Test for Light Touch (special test)
using a monofilament, apply perpendicular to the skin and hold for approx. 1 second, and then remove from skin
56
When should you not perform Light touch: cortical sensations tests?
these tests cannot be performed if the primary light touch sensation is abnormal
57
Describe the Two-Point Discrimination
“Tell me whether you can feel one point or two points”-- use a two-point discriminator tool
58
Describe Bilateral simultaneous touch: test for sensory extinction:
- patient should be able to attend to and identify a tactile stimulus that is applied to both sides of the body at the same time.
- Double simultaneous stimulation (DSS) is tested by touching homologous parts of the body on one side, the other side or both sides at once with the patient identifying which side or if both sides are touched with their eyes closed.
59
Describe Graphesthesia
“tell me what number I draw in the palm of your hand” (use a key or a similar object); this tests the dorsal column/medial lemniscus system and the parietal lobe
60
What's Conscious proprioception?
1) Joint movement: “tell me whether I am bending or straightening your joint”. Then ask the patient to match the final joint position with the opposite limb or to report the position of the joint; errors indicate dysfunction in the peripheral nerves, spinal cord, brainstem, or cerebrum
2) Joint position: passively flex or extend the joint; ask the patient to match the final joint position with the opposite limb
3) Vibration: use a tuning fork with a frequency of 128 Hz. Ask the patient, “tell me when the vibration stops”
61
Describe Sharp vs. Dull Sensation
Sharp, Prickling Sensation→ ask the patient to report “sharp” or “dull” ; use enough force just to indent the skin; if the patient reports feeling the stimulus, ask where they felt it
62
Describe Brush Allodynia Test for neuropathic pain (special test):
ask the patient “how does this feel?” and then gently stroke the patient’s skin with a 1-in wide foam brush; the normal response should be the perception of light touch; abnormal response is perception of pain
63
Describe Proprioception
- have pt report whether he or she can sense the position of a limb tests conscious awareness of proprioception
- but not the ability to use proprioceptive info to adjust movements.
64
Describe Stereognosis
- ability to use light tough, proprioceptive, and movement info to identify an object placed in hand.
- Ask the pt “Tell me what this is. You can move the object around in your hand.”
- Normal response: able to identify object
65
Describe Discriminative touch
- ask pt to report temp as hot or cold.
- Touch pt with test tubes filled with warm and cool water.
- This test is usually used to map areas of deficiency to determine whether the sensory loss fits a peripheral or dermatomal pattern
66
Nociceptors respond to stimuli that's...
damage or threaten tissue
67
What's described below?
(Neuropathic pain/Phantom pain/Central pain)
Pathologic neural response following trauma, inflammation, metabolic disorders, infection, tumor, toxin, or autoimmune disorder
Neuropathic pain
68
What's described below?
(Neuropathic pain/Phantom pain/Central pain)
Pain that seems to originate from a missing limb. The absence of sensory info causes neurons in the central nociceptive pathways to become overactive
Phantom pain
69
What's described below?
(Neuropathic pain/Phantom pain/Central pain)
caused by a lesion of the CNS and usually is localized to the area of the body deafferented by the lesion
Central pain
70
What's described below?
Complex Regional Pain Syndrome (CRPS) or Regional ?
a syndrome of pain, vascular changes, and atrophy
Complex Regional Pain Syndrome (CRPS)
71
What's described below?
Complex Regional Pain Syndrome (CRPS) or Regional ?
indicates that signs and symptoms present in a regional distribution rather than in a peripheral nerve or nerve root distribution
Regional
72
Describe Chronic Low Back Pain Syndrome
Decreased endurance of abdominal and back muscles
OTB 510
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