Chapter 7 Neurological System Disorders

Muscular Dystrophies/Atrophies

A group of degenerative disorders due to a hereditary disease process

Cerebral Palsy (CP): Diagnosis - Lesion in the Motor Cortex

A lesion in the __________________ will result in spacticity with flexor and extensor imbalance

Traumatic Brain Injury: Rancho Level of Cognitive Functioning - Level I: No Response: Total Assistance

Complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive, vestibular, or painful stimuli.

Peripheral Nervous System: LMN MOTOR (efferent)

Fibers originate from motor nuclei (cranial nerves) or anterior horn cells (spinal nerves)

Peripheral Nervous System: LMN SENSORY (afferent)

Fibers originate in cells outside of brain stem or spinal cord with sensory ganglia (cranial nerves) or dorsal root ganglia (spinal nerves)

Peripheral Neuropathies: Diagnosis

Focused on the cause of the symptoms Specific tests utilized include electromyography nerve conduction velocity, muscle biopsy, and examinations to identify systemic disorders.

CNS Support Structures// Blood supply CIRCLE OF WILLIS

Formed by anterior communicating artery connecting the two anterior cerebral arteries and the posterior communicating artery connecting each posterior and middlecerebral artery

CNS Support Structures// Ventricles

Four cavities or ventricles that are filled with cerebrospinal fluid and communicate with each other and with the spinal cord canal 1. Lateral Ventricles 2. Third Ventricle 3. Fourth Ventricle

Spina Bifida

Genetic, intrauterine, and/or environmental factors contribute to the neural tube defect involving the vertebral arches and the spinal column. Some studies suggest certain medication and a lack of folic acid may induce neural tube defects

Peripheral Nervous System: Spinal Level Reflexes INVOLUNTARY RESPONSES TO STIMULI

Basic, specific and predictable; dependent upon intact neural pathway (reflex arc). 1. Reflexes may be monosynaptic or polysynaptic (involving interneurons) 2. Provide basis for unconscious motor function and basic defense mechanisms.

Nerve Fiber types: B Fibers

Small, myelinated, conduct less rapidly; preganglionic automatic

Nerve Fiber types: C Fibers

Smallest, unmyelinated, slowest conducting 1. Dorsal Root: pain, reflex responses 2. Sympathetic: post-ganglionic sympathetics.

Post-Polio Syndrome (PPS)

Some motor neurons infected with the polio virus die (leaving paralyzed muscle cells), others survive. Recovered motor neurons develop new terminal axon sprouts that reinnervate muscle cells. After years of stability, these motor units break down, causing new muscle weakness. 1. degeneration of the axon sprouts explains the new weakness and fatigue, but the mechanism remains controversial 2. A current explanation is related to the overuse of individual motor neurons over time.

Parkinson's Disease: Stage of disease progression

Stage of disease progression is diagnosed using Hoehn and Yahr's five stage scale. Stage I = unilateral tremor, rigidity, akinesia, minimal or no functional impairment Stage II = bilateral tremor, rigidity or akinesia with or without axial signs, independent with ADL, no blance impairment Stage III = worsening of symptoms, first signs of impaired righteing reflexes, onset of disability Stage IV = requires help with some or all ADLs unable to live alone without some assistance, able to walk and stand unaided Stage V = Confined to a wheelchair or bed, maximally assisted.

Peripheral Nervous System: Spinal Level Reflexes FLEXOR (WITHDRAWL) REFLEX

Stimulus: cutaneous sensory stimuli Reflex arc: cutaneous receptors via interneurons to largely flexor muscles; multi-segmental response involving groups of muscles (polysynaptic) Functions: as a protective withdrawal mechanism to remove body part from harmful stimuli

Peripheral Nervous System: Spinal Level Reflexes INVERSE STRETCH (MYOTATIC) REFLEX

Stimulus: muscle contraction Reflex arc: afferent Ia fiber from Golgi tendon organ via inhibitory interneuron to muscle of origin (polysynaptic) 1. Functions to provide agonist inhibition, diminution of force of agonist contraction.

Peripheral Nervous System: Spinal Level Reflexes STRETCH (MYOTATIC) REFLEXES

Stimulus: muscle stretch Reflex arc: afferent Ia fiber from muscle spindle to alpha motoneuron projecting back to muscle of origin (monosynaptic) 1. Functions to maintain muscle tone, support agonist muscle contraction, and to provide feedback about muscle length 2. Clinically, sensitivity of the stretch reflex and intact ness of spinal cord segment are tested by applying stretch to the deep tendons (DTR) 3. Reciprocal inibition: via in inhibitory interneuron the same stretch stimulus inhibits the antagonist muscle 4. Reciprocal innervation: Describes the responses a stretch stimulus can have on agonist (autogentic facilitation), antagonist (reciprocal inhibition) as well as on synergistic muscles (facilitation)

Peripheral Nervous System: Spinal Level Reflexes CROSSED EXTENSION REFLEX

Stimulus: noxious timuli and reciprocal action of antagonists; flexors of one side are excited casing extensors on same side to be inhibited; opposite responses occur in opposite limb Reflex arc: cutaneous and muscle receptors diverging to many spinal cord motoneurons on same and opposite side (polysynaptic) Function: coordinates reciprocal limb activities such as gait

What are Neuroglia?

Support cells that do not transmit signals; important for myelin and neuron production maintenance of K+ levels and re-uptake of neurotransmitters following neural transmission at synapses

Peripheral Nervous System Autonomic Nervous System Fibers:

Sympathetic fibers at thoracolumbar spinal segments and parasympathetic fibers at craniosacral segments

Spina Bifida Occulta: Symptoms

Symptoms of this Spina Bifida...usually does not result in any symptoms. 1. occasionally slight instability and neuromuscular impairments, such as mild gait involvement and bowel and bladder problems may occur. 2 Occult Spinal Dysraphism may result in the spinal cord being split (diplomyelia) or being tied down and tethered (diastermatomyelia) which may lead to neurological damage and developmental abnormality as the child grows.

Parkinson's Disease: Medical management - Surgical interventions

Thalamotomy, Pallidotomy, Fetal tissue transplant, deep brain stimulators

Amyotrophic Lateral Sclerosis (ALS): Medical management

There is no specific treatment to slow the disease process Treatment is aimed at treating secondary complications such as spasticity (treated with antispasmodics), and prevention of aspirations (gastrostomy and modified diets)

Peripheral Nervous System: what cranial nerves carry parasympathetic fibers of ANS; involved in control of smooth muscles of inner eye (C.N. _____), salivatory and lacrimal glands (C.N. _____),parotid gland (C.N. _____), muscles of heart, lung and bowel (C.N. _____).

C.N. III, VII, IX, X Smooth muscles of inner eye: III Salivatory and lacrimal glands: VII Parotid gland: IX Muscles of heart, lung and bowel: X

Peripheral Nervous System: what cranial nerves are pure motor, innervating sternocleidomastoid, trapezius, and tongue?

C.N. XI, XII

Spinal Cord// Autonomic Nervous System (ANS) - AUTONOMIC PLEXUSES:

Cardiac, pulmonary, celiac (solar), hypogastric, pelvic

Stroke/Cerebral Vascular Accident (CVA) CEREBRAL INSUFFICIENCY

Due to transient disturbances of blood flow (transient ischemic attac TIA)

Spina Bifida: Medical Management - neonatal period

During the neonatal period precautions are taken to protect the sac from rupturing and from infection which may result in meningitis. - All or part of the sac may be removed 24-48 hours after birth.

CNS Support Structures// Meninges

Three membrains that envelop the brain 1. Dura Mater: outer, touch, fibrous membrane attached to inner surface of cranium; forms falx and tentorium 2. Arachnoid: delicate, vascular membrane 3. Subarachnoid space: formed by arachnoid and pia mater, contains cerebrospinal fluid and cisterns, major arteries 4. Pia Mater: thin, vascular membrane that covers the brain surface; forms tela choroidea of ventricles

Pain Pathways/Neurophysiology: Fast pain

Transmitted over A delta fibers. 1. processed inspinal cord dorsal horn lamina ( I & V) 2. Crosses to excite lateral (neo) spinothalamic tract. 3. Terminates in brain stem reticular formation and thalamus with projections to cortex. 4. Functions for localization, discrimination of pain.

Pain Pathways/Neurophysiology: Slow pain.

Trasmistted over C fibers. 1. Processed in psinal cord lamina (II & III to V) 2. Crosses to excite anterior (paleo) spinothalamic tract. 3. Terminates in brain stem reticular formation. 4. Excites reticular activating system (RAS) 5. Functions for diffuse arousal (protective/aversive reactions), affective and motivational aspects of pain. 6. Also terminates in thalamus with projections to cortex.

Spinal Cord// Autonomic Nervous System (ANS) Modulated by Brain Centers - CRANIAL NERVES

Visceral afferent sensations via glossopharyngeal, and vagus nerves; efferent outflow via oculomotor, facil, glossopharyn geal, and vagus nerves.

Peripheral Neuropathies

______________________ of a single nerve may be the result of trauma, pressure paralysis, forcible overextension of a joint, hemorrhage into a nerve, exposure to cold or radiation, or ischemic paralysis. 1. Multiple nerves may be affected in cases of collagen vascular disease, metabolic diseases (diabetes mellitus), or infectious agents (lyme disease) 2. Other causes include nutriionaldeficiency, malignancy, microorganisms, exposure to toxic agenst, and chronic alcohol abuse

Stroke/Cerebral Vascular Accident (CVA): CEREBRAL ARTERIOVENOUS MALFORMATION (AVM)

abnormal, tangled collections of dilated blood vessels that result from congenitally malformed vascular structures.

Chorea

brief, purposeless, involuntary movements of the distal extremities and face. Usually considered to be a manifestation of dopaminergic overactivity in the basal ganglia.

Peripheral Nervous System: Spinal Nerves Ventral (anterior) Root

efferent (motor) fibers to voluntary muscles (alpha motoneurons, gamma motoneurons), and to viscera, glands and smooth muscles (preganglionic ANS fibers)

Progressive supranuclear palsy

etiology: manifested by loss of voluntary, but preservation of reflexive eye movements, bradykinesia, rigidity, axial dystonia, pseudobulbar palsy, and dementia. onset, prevalence and prognosis: occurs in later middle life, affects 6.5/100,000 people, death occurs approximately 15 years after onset.

CNS Support Structures// Blood supply CAROTID SYSTEM

internal carotid arteries arise off of common carotids and brranch to form anterior and middle cerebral arteries; supplies a large area of brain and many deep structures

CNS Support Structures// Ventricles LATERAL VENTRICLES

large, irregularly shaped, with anterior (frontal), posterior (occipital) and inferior (temporal) horns; communicates with third ventricle through foramen of Monro

CNS Support Structures// Blood supply VERTEBROBASILAR SYSTEM

vertebral arteries arise off of subclavian arteries and unite to form the basilar artery; this vessel bifurcates into two posterior cerebral arteries; supplies the brain stem, cerebellum. occiptal lobe, and parts of thalamus

BRAIN//Cerebral hemispheres (telenecephalon)

Convolutions of gray matter composed of gyri (crests) and sulci (fissures) . 1. Lateral central fissure (sylvian fissure) separates temporal lobe from frontal and parietal lobes 2. Longitudinal cerebral fissure separates the two hemispheres 3. Central sulcus separates frontal lobe from the parietal lobe Paired hemispheres, consisting of 6 lobes on each side: frontal, parital, temporal, occipital, inslar, and limbic

Spinal Cord

Cylindrical mass of nerve tissue extending from the foramen magnum in skull continuous with medulla to the lower border of first lumbar vertebra in the conus medullaris

Peripheral Neuropathies: Medical Management

Guided by the underlying disease process, not the symptoms of the neuropathy. Treatment of the underlying systemic disorder (diabetes, tumor, multiple myeloma) may slow progression, although recovery is slow.

Brain// CEREBELLUM

Located behind dorsal pons and medulla in posterior fossa Structure: 1. joined to brain stem by 3 pairs of peduncles: superior, middle, and inferior 2. Comprised of 2 hemispheres and midline vermis; have cerebellar cortex, underlying white matter, and 4 paired deep nuclei 3. Archicerebellum (flocculonodular lobe) connects with vestibular system and is concerned with equilibrium and regulation of muscle tone 4. paleocerebellum (anterior lobes and vermis) receives input from proprioceptive pathways and is concerned with modifying muscle tone and synergistic actions of muscles; it is important in maintenance of posture and volunatary movement control 5. Neocerebellum (middle lobes) receives input from corticopontocerebellar tracts and olivocerebellar fibers; it is concerned with the smooth coodination of voluntary movements; ensures accurate force, direction and degree of movement.

CNS Support Structures// Ventricles THIRD VENTRICLE

Located posterior and deep between the two thalami; cerebral aqueduct communicates with third and fourth ventricle

Peripheral Nervous System What are peripheral nerves reffered to as?

Lower motor neurons (LMN)

Neuron Function: Neuronal Signaling what are myelinated axons?

Many axons are covered with myelin with small gaps (nodes of Ranvier) where myelin is absent; the action potentional jumps from one node to the next, termed saltatory conduction; myelin functions to increase speed of conduction and conserve energy

Spinocerebellar Degenerations: Medical management

Medical management for movement disorders is limited in many cases. 1. pharmacologic intervention may be able to dampen effects of the movement disorders. 2. agents utilized for this population include propanolol, clonazepam, clonidine, and anticholinergic agents depending upon symptomatology.

Peripheral Nervous System: What cranial nerves are mixed motor and sensory; involved in chewing (C.N.____) facial expression (C.N.____), swallowing (C.N.____ _____) vocal sounds (C.N.____), sensations from head (C.N.____ _____ ___), alimentary tract, heart, vessels, and lungs (C.N.____ ____), and taste (C.N.____ ____ _____)

Mixed: C.N. V, VII, IX, X Chewing: V Facial expression: VII Swallowing: IX, X Vocal Sounds: X Sensations from head: V, VII, IX Alimentary tract, heart, vessels, and lungs: IX, X Taste: VII, IX, X

Spina Bifida: onset, prevalence, and prognosis

Occurs in about 1 in every 1,000 births - incidence is decreasing and improved medical treatment has increased survival rate. The prognosis and degree of impairment is dependent on the level of the lesion and the extent of the neural tube defect of the vertebral arches and the spinal column - Lesions usally occur in the thoracic or lumbar spine.

Spina Bifida with Myelomeningocele

Protrusion of a sac through the spine containing cerebral spinal fluid and meninges as well as the spinal cord or nerve roots.

Spina Bifida with Meningocele

Protrusion of a sac through the spine, containing cerebral spinal fluid and meninges; however, does not include the spinal cord

CNS Support Structures// Cerebrospinal Fluid

Provides mechanical support (cushions brain), controls brain excitability by regulating ionic composition, aids in exchange of nutrients and waste products 1. produced in choroid plexuses in ventricles 2. Normal pressure: 70-180 mm/H2O 3. Total Volume: 125-150 cc

CNS Support Structures// Ventricles FOURTH VENTRICLE

Pyramid-shaped cavity located in pons and medulla; foramina (openings) of Luschka and Magendie communicate fourth ventricle with subarachnoid space

Spinal Cord Injury (SCI): Clinical Syndromes CENTRAL CORD

Resulting from HYPEREXTENSION injuries and presenting as more UPPER EXTREMITY deficits vs. lower extremities

Neuron Function: Neuronal Signaling REPOLARIZATION

Results from activation of K+ channels

Stroke/Cerebral Vascular Accident (CVA): Symptoms ANTERIOR CEREBRAL ARTERY (ACA) STROKE

Results in contralateral hemiplegia, grasp reflex, incontinence, confusion, apathy, and/or mutism

Stroke/Cerebral Vascular Accident (CVA): Symptoms MIDDLE CEREBRAL ARTERY (MCA) STROKE

Results in contralateral hemiplegia, hemianesthesia, homonymous hemianopsia, aphasia, and/or apraxia

Stroke/Cerebral Vascular Accident (CVA): Symptoms POSTERIOR CEREBRAL ARTERY (PCA) STROKE

Results in homonymous hemianopsia, thalamic pain, hemisensory loss, and/or alexia

Dystonia

Results in sustained abnormal postures and disruptions of ongoing movement resulting from alterations of muscle tone. May be generalized or focal.

Stroke/Cerebral Vascular Accident (CVA): Symptoms INTERNAL CAROTID ARTERY (ICA) STROKE

Results in symptoms similar to those associated with MCA CVA Results in contralateral hemiplegia, hemianesthesia, homonymous hemianopsia, aphasia, and/or apraxia

Tremor

Rhythmic, alternating, oscillatory movements produced by repetitive patterns of muscle contraction and relaxation - classified by rate, rhythm, and distribution, - identified as to whether they occur at rest (resting______) or during activity (action or intention _____)

CNS Support Structures// Bony Structure: SKULL (cranium)

Rigid bony chamber that contains the brain and facial skeleton, with an opening (foramen magnum at its base

Spina Bifida: Blocked Shunts

Shunts can becom blocked resulting in increased intra-cranial pressure: 1. Signs and symptoms during the first year of life include extreme head growth and often a tensoft spot on the forehead. 2. Signs and symptoms by the second year of life include severe headache, vomiting, and/or irritability 3. Intracranial pressure may contribute to seizure disorders and deterioration of physical and/or cognitive functioning 4. Intracranial pressure can possible lead to paralysis of the sixth cranial nerve resulting in visual impairments

Parkinson's Disease: Side Effects

Side effects are common when the disease is being managed pharmacologically 1. During early treatment, side effects from carbidopa-levodopa therapy are usually not a major problem 2. As the disease progresses, the drug works less evenly and predictaby. (As a result, some people may experience involuntary movements (dyskinesia), primarily when the medication is having its peak effects. The length of time for which each does is effective may begin to shorten (wearing-off effect) leading to more frequent doses) 3. The on-off effect, of long-term carbidopa-levodopa usage may cause parkinson's related movement problems to appear and disappear suddenly and unpredictably.

Traumatic Brain Injury: Rancho Level of Cognitive Functioning - what are the levels?

Level I: No response: Total Assistance Level II: Generalized Response: Total Assistance Level III: Localized Response: Total Assistance Level IV: Confused Agitated: Maximal Assistance Level V: Confused, Inappropriate Non-Agitated: Maximal Assistance Level VI: Confused Appropriate: Moderate Assistance Level VII: Automatic, Appropriate: Minimal Assistance for Daily Living Skills Level VIII: Purposeful, Appropriate: Stand-By Assistance Level IX: Purposeful Appropriate: Stand -By Assistance on request Level X: Purposeful, Appropriate: Modified Independent

Parkinson's Disease: Medical Management - Pharmacology

Levodopa - the metabolic precursor of dopamine Sinemet (levodopa/carbidopa) Dopamine agonists Anticholinergics (benadryl, artane, cogentin) - for rigidity and tremors Dopamine Releasers (Amantadine)

Demyelinating Disease: Multiple Sclerosis (MS) Onset, prevalence, and prognosis

More prevalent in areas futher north of the equator. Occurs in 100/100,000 in northern U.S.; 30/100,000 in southern U.S. Occurs between ages 15-50; it is most often diagnosed when persons are in their 30s Overall prognosis is variable with an unpredictable disease course

Interventions for seizure disorders: Occupational therapy evaluation and intervention

1. Assess and intervene for developmental delays as necessary. 2. Observe all medical and safety precautions. 3. Document and report and seizure activity, medication side effects, or behavioral changes.

Spinal Cord Injury (SCI): Complications AUTONOMIC DYSREFLEXIA - management

1. Identify the offending stimulus and relieve the underlying issue immediately. 2. Medications if no impact can be made by removing the irritant

Sensory Processing Disorders: presenting signs and symptoms - Sensory-based motor disorder

1. deficits in proprioceptive and vestibular systems. 2. dyspraxia: difficulty with planning movements, particularly those that are complex and nex 3. postural disorders: decreased muscle tone impacting on stability.

Peripheral Nervous System: which cranial nerves are pure sensory, carry special senses of smell, vision, hearing and equilibrium

C.N. I, II, VIII

Sensory Processing Disorders

1. etiology unkown. 2. subtle, primarily subcortical, neural dysfunction with impaired processing of sensory information and modulation of multisensory systems. 3. Symptoms are classified under the categories of: -Sensory modulation disorder (SMD) -Sensory-based motor disorder (SBMD) -Sensory discrimination disorder (SDD)

Peripheral Nervous System: what cranial nerves are pure motor, controlling eye movements and pupillary constriction?

C.N. III, IV, VI

BRAIN//Cerebral hemispheres (telenecephalon): Paired Hemispheres - TEMPORAL LOBE

1. primary auditory cortex: receives/processes autitory stimuli 2. Associative auditory cortex: processes auditory stimuli 3. Wernicke's area: language comprehension

Peripheral Nervous System: Spinal Nerves A motor unit consists of....

...The alpha motoneuron and the muscle fibers it innervates

Presenting Signs and Symptoms for Specific Classification of Seizures. SELECTED SEIZURE SYNDROMES - LANDAU-KLEFFER SYNDROM or acquired spileptic aphasia

1. progressive encephalopathy 2. loss of language skills 3. auditory agnosia (inability to distinguish differnt sounds) 4. behavioral disturbances such as inattention.

The term CVA or stroke applies to....

...Clinical Syndromes that accompany ischemic or hemorrhagic lesions.

What are the three different types of nerve fibers?

1. A Fibers 2. B Fibers 3. C Fibers

Seizure: Medical management

1. A neurologist is most often required to medically mange seizures. 2. Seizure disorders are treated with anticonvulsive medications. -Phenobarbital (luminal), carbamazepine (tegretol), phenytoin (Dilantin) and valproic acid (depakene) are used with grand mal seizures -Ethosuximide (Zarontin) is used with petit mal seizures -Carvamazepine and primidone are used with psychomotor seizures. -Clonazepam (clonopin), steroids, and CTH (hormone secreted by the pituitary gland) are used with myoclonic seizures.

Muscular Dystrophies/ Atrophies: Congenital myasthenia gravis

1. A disorder involving transmission of impulses in the neuromuscular junction 2. Onset starting near birth and occurring more frequently in males.

Stroke/Cerebral Vascular Accident (CVA): SYMPTOMS

1. Abrupt onset of unilateral neurological signs (weakness, vision loss, sensory changes, etc) 2. Symptoms progress over several hours to 2 days 3. Specific symptoms are determinded by the site of the infarct and the involved artery -Middle cerebral artery (MCA) stroke -Internal carotid artery (ICA) stroke -Anterior cerebral artery (ACA) stroke -Posterior cerebral artery (PCA) stroke Vertebrobasilar system

Cerebral Palsy (CP): Complications

1. A language and intellectual deficits occur in 50-75% of children with cerebral palsy 2. Seizures occur in 50% of children with cerebral palsy 3. Visual impairments occur in 40-50% of children with cerebral palsy. 4. Feeding disturbances

Trauma: Traumatic Brain Injury - Diagnostic Testing ADMINISTRATION OF GLASGOW COMA SCALE

1. A neurological scale which provides an objective method to record the CONSCIOUS STATE of a person. 2. It is used for initial evaluation and continuing assessment to determine a person's level of consciousness after head injury 3. A client is assessed against the scale's criteria which delineate a rage of points for three tests: eye, verbal, and motor responses 4. The resulting total points comprise the Glasgow Coma Score (GCS) 5. The score sum as well as the three separate values is considered 6. The highest total GCS is 15 (Fully conscious person) 7. The lowest possible total GCS is 3 (deep coma or death) 8. The GCS is interpreted as severe with GCS <8, moderate with GCS 9-12, and minor with GCS >13 9. Individual test scores as well as the total GCS score are documented (GCS 11 = E4, V3, M4 at 11:30pm)

Peripheral Neuropathies: symptoms

1. A syndrome of sensory, motor, reflex, and vasomotor symptoms 2. Symptoms include pain, weakness, and paresthesias in the distribution of the affected nerve

Cerebral Palsy (CP): Diagnosis - Lesion in the Cerebellum

A lesion in the ______________ results in ataxic movements and is characterize by a lack of stability so coactivation is difficult resulting in more primitive total patterns of movement.

Traumatic Brain Injury: Rancho Level of Cognitive Functioning - Level X Purposeful, Appropriate: Modified Independent

1. Able to handle multiple tasks simultaneously in all environments but may require periodic breaks 2. Able to independently procure, create, and maintain own assistive memory devices 3. Independently procure, create, and maintain own assistve memory devices 4. Independently initiates and carries out steps to complete familiar and unfamiliar personal, household, community, work , and compensatory strategies to complete them 5. Anticipates impact of impairments and disabilities on ability to complete daily living tasks and takes action to avoid problems before they occur but may require more than usual amount of time and/or compensatory strategies 6. Able to independently think about consequences of decisions or actions but may require more than usual amount of time and/or compensatory strategies to select the appropriate decision or action. 7. Accurately estimates abilities and independently adjusts to task demands 8. Able to recogniz the needs and feelings of others and automatically respond in appropriate manner 9. periodic periods of depression may occur 10. Irritability and low frustration tolerance when sick, fatigues and/or under emotional stress 11. Social interaction behavior is consistently appropriate.

Guillain-Barre Syndrome: Symptoms

1. Acute, rapidly progressive form of polyneuropathy characterized by symmetric muscular weakness and mild distal sensory loss/paresthesias. 2. Weakness is always more apparent than sensory findings and is at first more prominent distally. 3. Relatively minor sensory signs and symptoms occur. (the patient may complain of painful extremities. Subjective and objective sensory disturbances are common initailly.) Sensory disturbances: -most commonly occurring in a distal (stocking-glove) distribution -Deep tendon reflexes are lost and sphincters are spared -Respiratory failure and dysphagia may be seen in some cases.

Trauma: Traumatic Brain Injury - Diagnostic Testing

1. Administration of Glasgow Coma Scale 2. Administration of the Rancho Los Amigos Levels of Cognitive Functioning 3. CT scan and MRI to visualize intracranial structure damage

Stroke/Cerebral Vascular Accident (CVA): Nonmodifiable risk factors

1. Age: relative risk increases with age 2. Gender: males are at higher risk 3. Race: African American and Latino are at greater risk 4. Heredity

Stroke/Cerebral Vascular Accident (CVA): Medical Management - immediate care

1. Airway maintenance 2. Adequate oxygenation 3. Nutritional intervention (IV fluids, alternative feeding routes) 4. Decubiti prevention 5. Treatment of underlying cardiac dysfunction (dysrhythmias)

Traumatic Brain Injury: Rancho Level of Cognitive Functioning - Level IV Confused/Agitated: Maximal Assistance

1. Alert and in heightened state of activity 2. purposeful attempts to remove restrains or tubes or crawl out of bed 3. may perform motor activities such as sitting, reaching and walking but without any apparent purpose or upon another's request. 4. Very brief and usually non-puposeful moments of sustained alternatives and divided attention 5. Absent short-term memory 6. may cry out or scream out of proportion to stimulus even after its removal 7. May exhibit aggressive or flight behavior 8. mood may swing from euphoric to hostile with no apparent relationship to environmental events 9. unable to cooperate with treatment efforts 10. Verbalizations are frequently incoherent and/or inappropriate to activity or environment

Traumatic Brain Injury: Rancho Level of Cognitive Functioning - Level V Confused, Inappropriate Non Agitated: Maximal Assistance

1. Alert, not agitated but may wander randomly or with a vague intention of going home 2. may become agitated in response to external stimulaiton, and/or lack of environmental structure 3. Not oriented to person, place or time 4. Frequent brief periods, non-purposeful sustained attention 5. Severely impaired recent memory, with confusion of past and present in reaction to ongoing activity 6. Absent goal directed, problem solving, self-monitoring behavior 7. Often demonstrates inappropriate use of objects without external direction 8. May be able to perform previously learned tasks when structured and cues provided 9. unable to learn new information 10. Able to respond appropriately to simple commands fairly consistently with external structures and cues 11. Responses to simple commands without external structure are random and non-purposeful in relation to command 12. Able to converse on a social, automatic level for brief periods of time when provided external structure and cues 13. Verbalizationabou present events become inappropriate and confabulatory hen external structure and cues are not provided.

Interventions for seizure disorders: Post - Seizure care

1. Allow the individual to rest or sleep after the seizure. 2. Call a physician if this is the individuals first seizure, if the seizure is followed by another seizure (status epilepticus), or if the seizure last more than 5 minutes. 3. Notify the parents/guardians/caregivers or designated emergency contact person that a seizure has occured. 4. observe safety precaution if the individual seems groggy, confused, or weak following the seizure.

Stroke/Cerebral Vascular Accident (CVA): Medical Management - pharmacologic therapies

1. Antithrombotic therapy (antiplatelet and anticoagulation) is used for rapid recanalization and reperfusion of occlued vessels to reduce infarction area (aspirin, heparin) 2. Thrombolytic therapy is used in acute strokes to open occluded cerebral vessels and restore blood flow to ischemic areas (t-PA)

Presenting Signs and Symptoms for Specific Classification of Seizures. - GENERALIZED SEIZURE: MYOCLONIC-AKINETIC SEIZURE

1. Are not the same as infantile 2. are brief, involuntary jerking of the extremities, with or without loss of consciousness. 3. Akinetic seizures include a loss of tone 4. are difficult to control

Trauma: Traumatic Brain Injury Pharmacologic interventions

1. Antibiotics 2. Anticonvulsants 3. Sedatives 4. Antidepressants

Cerebral Palsy (CP): Medical Management

1. Antispasticity drugs 2. Orthopedic management to address development of scoliosis and joint contractures 3. Surgery may be indicated to decrease contractures and improve functional movement 4. medications for seizures if present 5. Dietary interventions and special feeding techniques for regularity in elimination and/or other medical complications

Spinocerebellar Degenerations: Friedrich's Ataxia

1. Autosomal recessive inheritance 2. Onset occurs in childhood or early adolescence 3. Symptoms: the prototype of spinal ataxia. -this process is characterized by gait unsteadiness, upper extremity ataxia, and dysarthria -tremor may be a minor feture -presentation also includes areflexia and loss of large fiber sensory modalities - As the disease progresses scoliosis and cardiomyopathy are common.

Overview of Occupational Therapy Evaluation and Intervention for Neurological System Disorders: Occupational Performance Evaluation

1. Basic activities of daily living. 2. Instrumental activities of daily living. 3. Durable medical equipment evaluation. 4. School/work and return to shool/work issues. 5. Play/leisure interests. 6. Mobility needs. 7. Social participation interests.

Presenting Signs and Symptoms for Specific Classification of Seizures. SELECTED SEIZURE SYNDROMES - INFANTILE SPASMS OR WEST SYNDROME, INFANTILE MYOCLONIC SEIZURES OR JACKKNIFE EPILEPSY

1. Begins at 3-9 months of age. 2. Dropping of the head and flexion of the arms occurs. 3. Seizures may occur hundreds of times per day 4. prognosis is generally poor 5. Spsms sometimes decrease after several years, but are often replaced by other seizure disorders such as tuberous sclerosis

Parkinson's Disease: Symptoms

1. Begins insidiously with a resting "pill-rolling" tremor of one hand. 2. Cardinal signs include, tremor, rigidity, resistance to passive motion that is not velocity dependent (cogwheel or lead pipe), akinesia, postural instability, festinating gait, falling backwards (retropulsion) or forwards (propulsion, mask face, micrographia.

What and the 6 main components that make up the CNS Support Structures?

1. Bony Structure 2. Meninges 3. Ventricles 4. Cerebrospinal Fluid 5. Blood-brain barrier 6. Blood supply

Post-Polio Syndrome (PPS): medical management

1. Bracing with orthoses and pacing daily activity 2. Stretching programs 3. Exercise program 4. Low doses of tricyclic antidepressants to relieve muscle pain 5. pyridostigmine to reduce fatigue and improve strength

Muscular dystrophies/ atrophies: Onset, prevalence, and prognosis

1. Can begin in infancy childhood, or adulthood 2. Progress may be rapid and fatal, or may remin stable throughout life (those starting early in life tend to be more severe and to progress more rapidly)

Cerebral Palsy (CP): Etiology

1. Caused by an injury and/or disease prior to, during, or shortly after birth resulting in brain damage and secondary neurological and muscular deficits. 2. Common causes during the perinatal period include lack of oxygen, intracranial hemorrhage, meningitis, chronic alcohol abuse, toxicosis, infections, genetic factors, endocrine and metabolic disorders.

What are the three main components of the spinal cord?

1. Central Gray Matter 2. White Matter 3. Autonomic Nervous System (ANS)

Spinal Cord Injury (SCI): Clinical Syndromes

1. Central cord 2. Brown-Sequard 3. Anterior Cord 4. Conus medullaris 5. Cuada Equina Syndrome

What are the four main parts of the brain?

1. Cerebral hemispheres (telencephalon) 2. Diencephalon 3. Brain Stem 4. Cerebellum

Spinocerebellar Degenerations: Multiple systems degeneration (olivopontocerebellar atrophies)

1. Charcterized by spasticity, extra pyramidal, sensory, lower motor neuron, and autonomic dysfunction 2. Onset occurs in young to middle life.

Seizure: diagnostic Criteria

1. Clinical observations of the obvious manifestations associated with the specific seizure disorder. 2. The EEG alone is not sufficient to diagnose a seizure disorder since the disorder does not always show up on the EEG and conversely abnormal EEG pattens may appear when there is no clinical evidence of seizures.

Neuropathic Pain: Disorders of peripheral roots and nerves.

1. Complex regional pain syndrome type II(formerly known as neuralgia): pain occurring along the branches of a nerve; frequently paroxysamal 2. Radiculalgia: neuralgia of nerve roots. 3. paresthesias, allodynia: with nerve injury or transection.

Spinal Cord// Autonomic Nervous System (ANS)

1. Concerned with innervations of involuntary structures: smooth muscle, heart glands; helps maintain homeostatis (constant internal body environment) 2. Divided into 2 divisions: sympathetic and parasympathetic; both have afferent and efferent nerve fibers; preganglionic and postganglionic fibers

Trauma: Traumatic Brain Injury - Symptoms

1. Concussion characterized by post-traumatic loss of consciousness 2. Cerebral contusion/laceration/edema accompanied by surface wounds and skull fractures 3. A variety of symptoms can result Hemiplegia or monoplegia and abnormal reflexes Decorticate or decerebate regidity Fixed pupils Coma Changes in vital signs

Traumatic Brain Injury: Rancho Level of Cognitive Functioning - Level VII Automatic, Appropriate: Minimal Assistance

1. Consistently oriented to person and place. within highly familiar environments. Moderate assistance for orientation to time 2. Able to attend to highly familiar tasks in a non-distraction environment for at least 30 min with minimal assistance to complete task 3. Minimal supervision for new learning 4. Initiates and carries out steps to complete familiar personal and household routine but has shallow recall for what he has been doing. 5. Able to monitor accuracy and completeness of each step in routine personal and household ADLs and modify plan with minimal assistance 6. Superficial awareness of condition but unaware of specific impairments and disabilities and the limits they place on ability to afely accurately and completely carry out his/her household, commmunity, work and leisure ADLs 7. Minimal supervison for safety in routine home and community activities 8. unrealistic planning for future 9. unable to think about conseequences of a decision or action 10. overestimates abilities 11. unaware of other's needs and feeling 12. oppositional/uncooperative 13. unable to recognize inappropriate social interaciton behavior

Traumatic Brain Injury: Rancho Level of Cognitive Functioning - Level Traumatic Brain Injury: Rancho Level of Cognitive Functioning - Leve VIII Purposeful, Appropriate: Stand-By assistance

1. Consistently oriented to person, place and time 2. Independently attends to and completes familiar tasks for 1 hour in distracting environments 3. Able to recall and integrate past and recent events 4. Uses assistive memory devices to recall daily schedule, "to-do" lists and record critical information for later use with stand-by assistance. 5. Initiates and carries out steps to complete familiar personal, household community, work and leisure routines with stand-by assistance and can modify the plan when needed with minimal assstance to take appropriate corrective action 6. Thinks about consequences for a decision or action with minimal assistance 7. Overestimates or underestimates abilities 8. Acknowleges other's needs and feelings and responds appropriately with minimal assistance 9. Depressed 10. Irritable 12. Low frustration tolerance/easily angered 13. Argumentative 14. self-centered 15. uncharacteristically dependent/independent 16. able to recognize and acknowledge inappropriate social interaction behavior while it is occurring and takes corrective action with minimal assistance

Spinal Cord// White Matter - DESCENDING FIBER SYSTEM (motor pathways) what are the 5 different tracts?

1. Corticospinal tracts 2. Vestibulospinal tracts 3. Rubrospinal tract 4. Reticulospinal System 5. Tectospinal Tract

Overview of Occupational Therapy Evaluation and Intervention for Neurological System Disorders: Performance Context Evaluation

1. Cutural barriers. 2. Architectual barriers. 3. Societal limitations (financial barriers, stigma) 4. Home evaluation. 5. School/work site evaluations

Sensory Processing Disorders: presenting signs and symptoms - tactile processing dysfunction manifestations

1. Deficits in modualation (regulation and organization) 2. Deficits in tactile discrimination

Sensory Processing Disorders: presenting signs and symptoms - Proprioceptive processing disorder manifestations.

1. Deficits in modulation. 2. Discrimination deficits demonstrated by poor awareness of position of body, body parts and body scheme. 3. Clumsiness, awkwardness. 4. Distractibility. 5. Motor planning and movement difficulties. 6. Reliance on visual cues or other cognitive strategies to motor plan, guide movements, and perfom tasks. 7. Use of too much or too little force (stomping when walking, breaking objects unintentionally) 8. Poor awarness of personal space 9. Seeks heavy resistance and pressure

Sensory Processing Disorders: presenting signs and symptoms - Vestibular processing disorder manifestations

1. Deficits in modulation: -hypersensitivity to movement, characterized by aversion to movement impacting on the sympathetic system -Hyposensitivity to movement characterized by the individual seeking intense vestibular stimulation without complaints of feeling dizzy, and by a tendency to be a thrill seekier unawar of potential danger. -Gravitational insecurity characterized by excessive fear during typical activities, especially when the individual's feet are off the ground, when moving backwards or upwards, in space waslkin on uneven terrain, jumping, getting on/off elevators, using any playground equipment involving movement, and when handline even minimal heights. 2. Vestibular discrimination deficits, characterized by the aboce symptoms; however symptoms are demonstrated on a subtle level. 3. low muscle tone 4. Postural-ocular deficits 5. Decreased balance and equilibrium reactions 6. Deficits in bilateral coordination 7. low endurance 8. Deficient motor planning and sequencing 9. Behavior responses include difficulty with attention, organixation of behavior, communication.

Traumatic Brain Injury: Rancho Level of Cognitive Functioning - Level II: Generalized Response: Total Assistance

1. Demonstrates generalized reflex response to painful stimuli 2. Responds to repeated auditory stimuli with increased or decreased activity 3. Responds to external stimuli with physiological changes generalized gross body movement and/or not purposeful vocalization. 4. Responses noted above may be same regardless of type and location of stimulation 5. Responses may be significantly delayed

The Autonomic Nervous System (ANS) is modulated by what two brain centers?

1. Descending autonomic system 2. Cranial nerves

Spina Bifida: Diagnosis

1. Detected prenatally through aminocentesis for levels of alpha-fetoprotein and acetylcholinesterase, and ultrasound if indicated. 2. A less reliable means of prenatal detection involves determining the amount of alpha fetoprotein in the mother's blood

Cerebral Palsy (CP): Diagnosis

1. Detected usually by 12 months of age 2. Sometimes diagnosis may not be identified in early infancy (An infant may initially present with hypotonia. As the child's neuromotor status Evolves Spasticity may develop. The child may present with primitive reflexes and automatic reactions, hyperrresponsive reflexes, clonus, variable tone, asymmetry, involuntary movements, feeding difficulties due to oral motor impairments, cognitive, and other develpmental delays.) 3. Persistence of primitive reflexes contributes to diagnosis and these may extend into adulthood.

Muscular dystropies/atrophies: Diagnosis

1. Detection is confimed by blood tests for muscle enzymes or muscle proteins, nerve conduction velocity, electromyography, and if indicated muscle or nerve biopsy. 2. Inmuscular dystrophies blood tests demonstrate a high elevated level of creatine kinase (CK) 3. Common Symptoms include hypotonia, muscles weakness, and atrophy

Guillain-Barre Syndrome: Diagnosis

1. Diagnosis is based on clinical symptoms 2. Lumbar puncture reveals increased protein without cells in the cerebrospinal fluid. 3. electromyography and nerve conduction studies may suppor the diagnosis. 4. Segmental demyelination is apparent and in severe cases, axonal degeneration accompanies the demyelination.

Demyelinating Disease: Multiple Sclerosis (MS): Diagnosis

1. Diagnosis is largely based on symptoms 2. Slowly progressive CNS disease characterized by patches of demyelination in the brain and spinal cord 3. basic diagnostic criteria are evidence of multiple neurological disturbance in an individual between 10 and 59 years old 4. Diagnostics may include MRI to detect lesions, evoked potentials to measure conduction along sensory pathways, and cerebrospinal fluid examination

Myasthenia Gravis: Diagnosis

1. Diagnosis is often missed because of the rarity of the disease and the vagueness of symptoms. 2. Characterized by episodic muscle weakness, chiefly in muscles innervated by cranial nerves. 3. The possibility of ___________________ is suggested by any of the below symptoms and is confirmed by response to anticholinesterase drugs.

Sensory Processing Disorders: presenting signs and symptoms - tactile processing dysfunction manifestations - DEFICITS IN TACTILE DISCRIMINATION

1. Difficulty interpreting tactile information in a precise and efficient manner. -Contributes to impaired body scheme and somatodyspraxia ( a disorder in motor planning due to poor tactile perception and proprioception) -Contributes to awkward ness in fine and cross motor tasks and impaired manipulation skills, visual perception, and eye-hand coordination -Hinders ability to learn about properties and substances. 2. Difficulty with localizing tactile stimuli -impaired stereognosis and decreased fine motor and eye-hand coordination skills may be deomonstrated in difficulties with writing and cutting with scissors and knife.

Spinal Cord// White Matter - ASCENDING FIBER SYSTEM (sensory pathway) what are the 4 tracts?

1. Dorsal columns/medial lemniscal system 2. Spinothalamic tracts 3. Spinocerebellar tracts 4. Spinoreticular tracts

Parkinson's Disease: Etiology, Prevalence, onset, and prognosis

A hypokinetic CNS movement disorder that is idiopathic, slowly progressive, and degenerative 1. Onset of the disease is usually after age 40, with increasing incidence in older age groups 2. occurs in 1% of the population over 50 3. Rate of deterioration ranges from 2-20 years

Muscular dystropies/atrophies: Major Types

1. Duchenne's 2. Arthrogryposis multiplex congenita 3. Limb-girdle Muscular dystrophy 4. Fascioscapulohumeral muscular dystrophy 5. Spinal muscular atrophy 6. Congenital myasthenia gravis 7. Charcot-Marie-Tooth disease 8. Myopathies

Demyelinating Disease: Multiple Sclerosis (MS) medical management is symptom-specific

1. During acute exacerbation, anti-inflammatory drugs are used to control symptoms 2. Antispasmodics (Baclofen) may be effective to counteract spasticity 3. management of bowel and bladder dysfunction may require pharmacologic intervention. Catheterization (indwelling or intermittent) is necessary in many cases of bladder dysfunction.

Sensory Processing Disorders: Sensory-based motor disorder (SBMD)

1. Dyspraxia 2. Postural disorders

Pain- Occupational Therapy Intervention

1. Educate the individual about contributing factors 2. Assist the individual in identifying and responding adaptively to pain behaviors. -Remove behavioral reinforcers -Establish a behavior contract -provide positive reinforcers, educational support -demonstrate change, allow person to experience success -pactice well behaviors. 3. Assist the individual in developing strategies and using techniques to manage pain. -Teach coping skills/stress management/asssertive communication -Provide relaxation training. (progressive relaxation techniques (Jacobson's), deep breathing exercise, guided imagery, yoga, tia chi, Ai chi, Biofeedback. 4. Refer to other professionals for direct pain/symptom control interventions 5. Establish a realistic daily activity program. -Improve overall level of conditioning: daily walking program -Improve overall functional capacity, independence in functional mobility skills, activities of daily living and meaningful occupaitons. -Prescribe assistive devices as appropriate. -Teach enrgy conservation techniques. -Provide meaningful diversional activities. 6. Provide family education.

Common injuries of the brachial plexus seen in children include:

1. Erb's palsy 2. klumpke's palsy

Pain Pathways/Neurophysiology

1. Fast pain 2. Slow pain 3. Intrinsic inhibitory mechanism -Gate control theory -Descending analgesic system

Pain Pathways/Neurophysiology Intrinsic inhibitory mechanisms

1. Gate control theory: transmission of sensation at spinal cord level is controlled by balance between large fibers (A alpha, A beta) and small fibers (A delta, C) - activity of large fibers at the level of first synapse can block activity of small fibers at the level of first synapse can block activity of small fibers and pain transmission (counter-irritant theory). 2. Descending analgesic systems: endogenous opiates (endorphins, enkephalins) produced throughout CNS in periaqueductal gray, raphe nuclei, and pituitary gland/hypothalamus; can depress pain transmission at various sites through mechanisms of presynaptic inibition.

Classification of Seizures.

1. Generalized Seizures -Tonic-clonic seizures/grand mal seizures -Myoclonic-akinetic seizure -Absence seizures or petit mal seizures 2. Partial Focal Seizures -Simple Partial seizures -Complex partial or psychomotor seizures 3. Selected Seizure Syndromes -Infantile spasms or West syndrome, infantile myoclonic seizures or jackknife epilepsy -Lennax-Gastaut syndrome -Landau-kleffer syndrom or acquired eplieptic aphasia 4. Simple febril Seizures

Brain// Diencephalon - EPITHALAMUS

1. Habenular nuclei: integrate olfactory, visceral and somatic afferent pathways 2. Pineal gland: secretes hormones that influence the pituitary gland and several other organs; influences cicadian rhythm

Parkinson's Disease: Additional Side Effects of medications

1. Hallucinations 2. A drop in blood pressure when standing (orthostatic hypotension) 3. Nausea 4. Despite the potential side effects, carbidopa-levodopa typically allow people with parkinson's disease to extend the time that they are able to lead relatively normal lives and in many cases is effective for a number of years.

Assessment of Chronic pain

1. History: determine cheif complaints, description of onset, and mechanism of injury. 2. Determine localization: chronic pain is poorly localized not well defined. 3. Identify nature of pain: constant , intermittent 4. Determine subjective assessment using pain intensity rating scales: 5. Determine irritating stimuli/activities. 6. Physical Examination 7. Assess degree of suffering 8. assess for functional changes 9. Assess for consequences of pain, behavioral impact, and secondary gains, 10. Assess for depression, anxiety 1.. Assess for prescription drug misue 12 Assess for dependence on health care system: multiple health care providers, clinical services, "shopping around" behaviors 13. Determine responsiveness of pain to physiological intervention/treatments: chronic pain is often unresponsive. 14 Determine motivational/affective components.

Presenting Signs and Symptoms for Specific Classification of Seizures. PARTIAL FOCAL SEIZURE: COMPLEX PARTIAL OR PSYCHOMOTOR SEIZURES

1. symptoms vary 2. there are alterations in consciousness and unresponsiveness. 3. Automatic motions, such as lip smacking, chewing and swallowing, and nervous movement of the hands/fingers and repetitive movements occur. 4. Visual and auditory sensations occur just before the seizure

Traumatic Brain Injury: Rancho Level of Cognitive Functioning - Level IX purposeful, appropriate: Standby Assistance on Request

1. Independently shifts back and forth between tasks and completes them accurately for at least two consecutive hours 2. uses assitve memory devices to recall daily schedule "to do list" and record critical information for later use with assistance when requested 3. Initiates and carries out steps to complete familar personal, household, work and leisure tasks independently and unfamiliar personal, household, work and leisure tasks with assistance with requested 4. Aware of and acknowledges impairments and disabilities when they interfere with tasks completion and takes appropriate corrective action but requires stand-by assist to anticipate a problem before it occurs and take action to avoid it. 5. Able to think about consequences of decisions or actions with assistance when requested 6. Accurately estimates abilities but requires stand-by assistance to adjust to tak demands 7. Acknowledges other's needs and feelings and responds appropriately with stand-by assistance 8. Depression may continue 9. May be easily irritable 10. May have low frustration tolerance 11. Able to self monitor appropriateness of social interaction with stand-by assistance

Brain// Diencephalon - HYPOTHALAMUS

1. Integrates and controls the functions of the autonomic nervous system and the neuroendocrine system 2. Maintains body homeostasis: regulates body temperature, eating, water balance, anterior pituitary function/sexual behavior, and emotion.

Peripheral Nervous System: what are the 6 different spinal level reflexes?

1. Involuntary responses to stimuli 2. Stretch (myotatic) reflexes 3. Inverse stretch (myotatic) reflex 4. Gamma reflex loop 5. Flexor (withdrawal) reflex 6. Crossed extension reflex

Spinal Cord Injury (SCI): Complications AUTONOMIC DYSREFLEXIA - Irritants

1. Irritants that would normally cause pain to areas below the spinal injury specific to the bowel include, bowel irritation or over-distention (constipation/impaction, distention during bowel program (digital stimulation), hemorrhoid infection or irritation) 2. Irritants specific to the bladder include bladder infection or over distention (UTI, urinary retention, blocked catheter, overfilled urine collection bag, non-compliance with intermittent catheterization program. 3. Skin-related irritants can include any skin irritation below area of injury (decubitus ulcers, ingrown toenails, burns, tight or restrictive clothing or pressure to skin from clothing restrictions or wrinkles in clothing) 4. Sexual activity irritants can include over-stimulation during sex, stimuli to the pelvic region that would be felt as pian if sensation were intact, menstral cramps, labor and delivery. 5. Other irritants can include heterotopic ossification/myositis ossificans, skeletal fractures and appendicitis

Peripheral Nervous System What are the different functional components of peripheral nerves (LMN)

1. Motor (efferent) 2. Sensory (afferent) 3. Autonomic Nervous System fibers

Myasthenia Gravis: Medical Management

1. treatment includes cholinesterase inhibitors, corticosteroids, immunosuppressive agents, and plasmapheresis 2. the anticholinergics and plasma pheresis treat current symptoms. 3. Corticosteroids and immunosuppressives may alter the disease course by interfering with autoimmune pathogenesis .

Peripheral Nervous System: How many pairs of spinal nerves are there?

31 pairs of spinal nerves; spinal nerves are divided into groups, and correspond to vertebral segments; each has a ventral root and a dorsal root Cervical: 8 Thoraces: 12 Lumbar: 5 Sacral: 5 Coccygeal

Muscular Dystrophies/ Atrophies: Specific symptoms

1. Low muscle tone and weakness contributes to abnormal movement patterns and delayed developmental milestones. 2. There may be difficulty with oral motor feeding, necessitating as nasogastric or gastrostomy tube. 3. Weakness contributes to deformities of the extremities and spine 4. Difficulty with breathing may require tracheostomies or mechanical ventilators, and frequently results in death.

BRAIN//Cerebral hemispheres (telenecephalon): BASAL GANGLIA

1. Masses of gray matter deep within the cerebral hemispheres, including the corpus striatum (caudate nucleus and lenticular nuclei), amygdaloid nucleuss, and claustrum. The lenticular nuclei are further subdivided into the putamen and globus pallidus 2. Forms an associated motor system (extrapyramidal system) with other nuclei in the subthalamus and midbrain 3. has numerous fiver interconnections - caudate loop (complex loop) functions in association with asociation cortex in the formation of motor plans - Putamen loop (motor loop) functions in association sensorimotor cortex to scale and adjust movements.

What are the 3 parts of the Brain Stem?

1. Midbrain (mesencephalon) 2. Pons 3. Medulla Oblongata

Assessment of Chronic pain: Assess for consequences of pain, behavioral impact, and secondary gains.

1. Monetary benefits (malingering, insurance claims). 2. sympathy and attention 3. Avoidance of undesirable tasks.

Amyotrophic Lateral Sclerosis (ALS)

1. Motor neuron disease of unknown etiology characterized by progressive degeneration of corticospinal tracts and anterior horn cell or bulbar efferent neurons. 2. The disease is more prevalent in men thatn women at a ratio of 1.2:1 3. Onset occurs at an average age of 57 4. Death usually occurs in 2-5 years

Hemispheric Specialization: Right Hemisphere

1. Movement of left side of body 2. Processing of sensory information from left side of body 3. Visual reception from left field 4. Visual spatial processing 5. Left motor praxis 6. Nonverbal memory 7. Attention to incoming stimuli 8. Emotion 9. Processing of nonverbal auditory informaiton 10. Interpretation of abstract information 11. Interpretation of tonal inflections

Hemispheric specialization: Left hemisphere

1. Movement of right side of body 2. Processing of sensory information from the right side of the body 3. Visual reception from right field 4. Visual verbal processing 5. Bilateral motor praxis 6. Verbal memory 7. Bilateral auditory reception. 8. Speech 9. Processing of verbal auditory information

Demyelinating Disease: Multiple Sclerosis (MS): Symptoms

1. Multiple and varied neurologic symptoms and signs usually with remission and exacerbations 2. Onset of symptoms is usually insidious. 3. Paresthesias in one or more extremities, on the trunk, or in the face. 4. weakness or clumsiness in the leg or hand is common 5. Visual disturbance (diplopia, partial blindness, nystagmus, eye pain) 6. emotional disturbances (liability, euphoria, and reactive depression. 7. vertigo 8. bladder dysfunction 9. cognitive features may include apathy, memory loss, lack of judgment and inattention 10. sensorimotor findings mayy include: spasticity, increased reflexes, ataxia, weakness, gait instability, easy fatigue, hemiplegia or quadriplegia 11. The course of the symptoms is highly variable and may follow one of four patterns. -relapsing remitting -secondary progressive -primary progressive -Progressive relapsing

What are neuron groupings and types?

1. Nuclei: are compact groups of nerve cell bodies; in the peripheral nervous system these groupings are called GANGLIA 2. Projection Neurons: carry impulses to other parts of the CNS 3. Interneurons: are short relay neurons. 4. Axon bundles: are called tracts or fasiculi; in spinal cord, collections of tracts are called columns, or funiculi

Muscular Dystrophies/ Atrophies: Fascioscapulohumeral muscular dystrophy

1. Occurs in early adolescence 2. Involves the face, upper arms, and scapular region, causing masking and decreased mobility of the face and the inability to lift the arms above shoulder level.

Spina Bifida: Tethered Cord Syndrome

1. Occurs in the tail end of the spinal cord when it is stretched as a result of compression, being trapped with a fatty mass, or a developmental abnormality. 2. Visible signs include a hairy patch of skin, a hemangioma, and/or a dimple of the lower spine 3. Difficulties with bowel and bladder, gait disturbances, and/or deformities of the feet may result 4. Surgical intervention may be indicated

Stroke/Cerebral Vascular Accident (CVA): Prevalence, onset, and prognosis

1. On average, a U.S. citizen incurs a stroke every 40 seconds, every 4 min someone dies from a stroke 2. It's the 3rd larges cause of death, ranking behind "diseases of the hear" and all forms of cancer. 3. Stroke is a leading cause of serious, long-term disability in the united states 4. The prevelance of stroke in 2006 was 6,400,000 5. Data show that about 795,000 people incur a new or recurrent stroke each year. About 610,000 of these are first attacks and 185,000 are recurrent attacks.

Muscular Dystrophies/ Atrophies: Limb-girdle muscular dystrophy

1. Onset begins between the first and third decades of life 2. proximal muscles of the pelvis and shoulder are initially affected 3. Typically progresses slowly

Acute pain

1. Pain provoked by noxious stimulation. 2. Associated with an underlying pathology (injury or acute inflammation/disease). 3. Signs include sharp pain and sympathetic changes (increased heart rate, increased blood pressure, pupillary dilation, sweating, hyperventilation, anxiety, protective/escape behaviors)

Sensory Processing Disorders: Occupational Therapy evaluation

1. Parent interview regarding medical and developmental history. 2. teacher interview regarding school performance, play and behaviors. 3. Informal observations of performance and behavior in a variety of settings (classroom, playground, home) 4. Formal assessment of clincal observations using Aryes unpublished and nonstandardized tool: items to be observed include specific reflexes, crossing body midline, bilateral coordination, muscle tone. 5. Assess using standardized tests for tactile processing, vestibular-proprioceptive processing, visual perception, practic ability and their impact on occupational functioning.

Spinal Cord Injury (SCI): Complications AUTONOMIC DYSREFLEXIA - prevention

1. Teach person/caregiver frequent pressure relief principles 2. Ensure compliance with intermittent catheterization 3. Practice well-balanced diet habits 4. Ensure medication compliance 5. Educate the person with the condition (and/or at risk) and caregivers to recognize the cause, signs, and symptoms (sweating, headache); initiate first aid procedures to deal effectively with the occurrence, and use prevention methods for this condition.

Overview of Occupational Therapy Evaluation and Intervention for Neurological System Disorders: General Intervention/Treatment Guidelines

1. Positioning (seating and wheeled mobility prescription; bed positioning; pressure reduction and pressure relief techniques) 2. Postural control training for seated and standing activities. 3. Motor learning approaches. 4. Motor control retraining/relearning for functional integration of affected limbs. 5. Specific ADL training/retraining/adaptation. 6. Prescription of assitive devices and technology. 7. Splinting for contracture prevention and/or enhancement of function (tenodesis splint) 8. Family/caregiver education. 9. Congnitive perceptual retraining/compensation in context of functional activities. 10. Visual skills retraining and/or adaptation (eye patch for diplopia) 11. Intervention for sexual dysfunction. 12. Bowel and bladder training with adaptive techniques and equipment 13. Skin care education 14. Durable medical equipment prescription. 15. Sensory re-education 16. Assistance with development of coping strategies. 17. Community re-integration 18. Work hardening programs for adults. 19. Collaboration with educational team for children

BRAIN//Cerebral hemispheres (telenecephalon): Paired Hemispheres - PARIETAL LOBE

1. Postcentral gyrus: primary sensory cortex for integration of sensation 2. Receives fibers conveying touch, proprioceptive, pain and temperature sensations from opposite side of body

Brain// Diencephalon is made up of what 3 components?

1. Thalamus 2. Subthalamus 3. Hypothalamus 4. Epithalamus

Muscular Dystrophies/ Atrophies: Medical Management

1. Prescibed medications to decrease pulmonay complications and prolong life. 2. Nurtritional managemtn for difficulties with feeding and the tendency to gain weight secondary to inactivity 3. Prevention of skin breakdown and decubitus ulcers 4. Steroids to help delay or reverse muscle weakness; however, the undesirable side effects associated with steroids bring their use into question.

Parkinson's Disease: Diagnostic Testing

1. Presence of cardinal signs. 2. Degeneration in dopaminergic pathways in the basal ganglia, primarily in the substantia nigra 3. Positive response to Sinemet (Levodopa/Carbidopa)

Spinal Cord Injury (SCI): Medical management

1. Prevention of further cord damage via stabiliation 2. Traction and rest for unstable injuries 3. Surgery with internal fixation 4. Diuretic prescription to decrease inflammation 5. Bladder care 6. Decubiti Prevetion 7. Control of autonomic dysreflexia and orthostatic hypotension 8. Prevention of thrombus formation 9. Treatment for heterotopic ossification

Assessment of Chronic pain: Determine motivational/affective components.

1. Previous experience with pain. 2. learned responses to pain 3. perception of control over pain 4. ethnic/cultural aspects of pain. 5. Familial response to pain behavior.

BRAIN//Cerebral hemispheres (telenecephalon): Paired Hemispheres - OCCIPITAL LOBE

1. Primary visual cotex: receives/processes visual stimuli 2. Visual Association cortex: processes visual stimuli

Trauma: Traumatic Brain Injury Glasgow Coma Scale: Best Eye Response (E)

4- Eyes opening spontaneously 3-Eyes opening to speech 2- Eyes opening in response to pain 1- No eye opening

Spinocerebellar Degenerations: Cerebellar cortical degeneration

1. Pthologic changes are seen in the cerebellum and the inferior olives 2. Onset begins between ages 30-50 3. Symptoms: cerebellar symptoms are the only signs detectable

Interventions for seizure disorders: First aid procedures for seizures

1. Remain Calm 2. Remove dangerous objects and protect the individual from harm, without interering with his or her movements. 3. If the individual is upright, gently guide them to the floor and loosen clothing 4. Turn the individual on his/her side to prevent choking. 5. Do not insert anything between the indivudal's teeth. 6. Do not be alarmed if the individual seems to stop breathing momentarily 7. If the individual's breathing actually stops, use standard rescue breathing techniques.

Spinal Cord Injury (SCI): Complications

1. Respiratory Complications, decreased vital capacity, pneumonia 2. Decubitus ulcer formation 3. Orthostatic Hypotension: an excessive fall in blood pressure upon assuming the upright position 4. Deep Vein thrombosis 5. Autonomic dysreflexia: an abnormal response to a noxious stimulus that results in an extreme rise in blood pressure, pounding headache, and profuse sweating. This complication is deemed a medical emergency if not reversed by removing the irritating stimulus quickly. 6. Urinary tract infection 7. Heterotopic ossification, the formation of bone in abnormal anatomical locations.

Trauma: Traumatic Brain Injury - Prevalence, onset, and prognosis

1. Responsible for more deaths and disabilities than any other neurologic cause in the populaiton under age 50 2. Males are twice as likely to incure a TBI with the highest risk group being 15-29 year-ilds 3. 400,000 new injuries are reported each year.

Trauma: Traumatic Brain Injury Medical management

1. Resucitation 2. Management of respiratory dysfunction 3. Cardiovascular monitoring 4. Surgical, pharmacologic, or mechanical means to decrease intracranial pressure 5. Neurosurgery to manage lacerated vessels and depressed skull fractures

Brain// Diencephalon - THALAMUS

1. Sensory nuclei: integrate and relay sensory information from body, face, retina, cochlea, and taste receptors to cerebral cortex and subcortical regions; smell (olfaction) is the exception 2. Motor nuclei: relay motor information from cerebellum and globus pallidus to precentral motor cortex 3. other nuclei: assist in integration of visceral and somatic functions.

Sensory Processing Disorders: Sensory modulation disorder

1. Sensory overresponsivity 2. Sensory underresponsivity 3. Sensory seeking/craving

Guillain-Barre Syndrome: Medical Management

1. Severe cases constitute a medical emergency requiring constant monitoring of vital signs. 2. Respiratory support may be necessary in some cases 3. Plasmapheresis may be utilized to slow symptoms or halt progression 4. intravenous immunoglobulin has been utilized effectively.

Spina Bifida: Infected Shunts

1. Signs and symptoms include vomiting, lethargy, and/or fever 2. Seizures and deterioration of physical and/or cognitive functioning may result.

Assessment of Chronic pain: Determine subjective assessment using pain intensity rating scales

1. Simple descriptive scales: verbal report (select the words that best describe your pain.) 2. Semantic differentiation scales (McGill pain Questionnaire) 3. Numerical rating scales (rate pain on a scale of 1 to 10) 4. Visual analog scale (bisect line where your pain falls, from mild to severe pain) 5. Spatial distribution of pain: using drawings to plot location and type of pain.

Spina Bifida: Classification

1. Spina Bifida Occulta 2. Spina Bifida with Meningocele 3. Spina Bifida with Myelomeningocele

Spinal Cord Injury (SCI): Specific symptoms

1. Spinal Shock (4-8 weeks), all reflex activity is obliterated below the level of the injury presenting as flaccid paralysis 2. Sensory deficits may be partial loss or complete 3. Loss of bowel/bladder control 4. Loss of temperature control below the lesion 5. Decreased respiratory function 6. Sexual dysfunction 7. Changes in muscle tone (spasticity in upper motor neuron lesions; flaccidity in lesions below L1) 8. Loss of motor function resulting in tetraplegia (quadriplegia) or paraplegia; may be complete or incomplete.

Sensory Processing Disorders: presenting signs and symptoms

1. Stress and frustration demonstrated in performance of everyday activities 2. Difficulties with play, learning, social situations, and other developmental functions. 3. Difficulty with conceiving, planning, sequencing, or executing novel actions (dyspraxia) - a tendency to avoid or reject simple motor challenges. 4. poor initiation of activities as demonstrated in some children due to deifficulty generating ideas (ideation). 5 Difficulty with goal directed action the environment, known as an adaptive response. 6. responses may present along a continuum of underresponsivity to over-responsivity of multisensory processing and sensory seeking. 7. Tactile processing dysfunction manifestations 8. Proprioceptive processing disorder manifestations 9. vestibular processing disorder manifestations 10. sensory-based motor disroder.

Peripheral Nervous System: Spinal Level Reflexes GAMMA REFLEX LOOP

1. Stretch reflex forms part of this loop 2. Allows muscle tension to come under control of descending pathways (reticulospinal, vestibulospinal and others) 3. Descending pathways excite gamma motor neurons causing contraction of the muscle spindle, and in turn increase stretch sensitivity and increase rate of firing from spindle afferents; impulses are then conveyed to alpha motor neurons

Lower Motor Neuron System Sturcture & Lesion Symptoms

1. Structures: Cell bodies in the anterior horn of the spinal cord, spinal nerves, the cranial nerve fibers that travel to target muscles 2. Symptoms of a lesion: flaccidity, decreased or absent deep tendon reflexes, atrophy

Upper Motor Nuron System Structure & Lesion Symptoms

1. Structures: any nerve cell body or fiber in the spinal cord (except the anterior horn cells), all superior structures (gray and white matter affecting motor function and descending nerve tracts), cranial nerve nuclei 2. Symptoms of a lesion: increased deep tendon reflexes, spasticity, clonus, emergence of primitive reflexes including Babinski's sign, exaggerated cutaneous reflexes, autonomic dysreflexia, faccidity may occur at the level of the lesion.

Muscular Dystrophies/ Atrophies: Myopathies

1. Symptoms are similar to dystrophies; however myopathies progress slowly; resulting in a better prognosis 2. Weakness of the face, neck and limbs is characteristic

Sensory Processing Disorders: presenting signs and symptoms - tactile processing dysfunction manifestations - DEFICITS IN MODULATION (regulation and organization)

1. Tactile defensiveness: over-responsivity to ordinary touch sensations. -The individual may demonstrate irritation and discomfort from a variety from textures such as clothing, sand, grass, glue, water, paint and/or food. -The individual may dislike brushing his/her teeth or hair. - the individual may demonstrat various behavioral responses including distractibility ange, hostility, temper tantrums, fear, and/or distress. 2: under-responsivity to tactile stimuli as demonstrated by diminished sensory registration and responsiveness. -The individual may not respond to normal levels of tactile input and may seek disproportionate amounts of stimuli to gain environmental information (excessive touching of people and objects)

Spina Bifida Occulta

A bony malformation with separation of vertebral arches of one or more vertebrae with no external manifestations. 1. Occult spinal dysraphism (OSD): when external manifestations such as a red birthmark (hemangioma or flame nevus), patch of hair, a dermal sinus (opening in skin), a fatty benign tumor (lipoma), or dimple covering the site are present. 2. Spina bifida cystica: and exposed pouch.

Myoclonus

A brief and rapid contraction of a muscle or group or muscles.

Muscular Dystrophies/ Atrophies: Spinal muscular atrophy

1. The infantile form known as Werding-Hoffman disease has a life expectancy up to approximately two years of age. 2. The intermediate formis detected six months to 3 years of age and progresses rapidly with a life expectancy of early childhood.

Tics

A brief, rapid, involuntary movements often resembling fragments of normal motor behavior. They tend to be stereotyped and repetitive, but not rhythmic.

Seizure Disorders: Epilepsy

A chronic state of recurrent seizures.

Cerebral Palsy (CP): Diagnosis - Lesion in the Basal Ganglia

A lesion in the _____________ results in fluctuations in muscle tone causing dyskinesia, dystonia, or athetosis; characterized by choreoathetosis with jerky involuntary movements more proximal than distal and lack of cocontractions; or writhing involuntary movements more distal then proximal.

Seizure: Impact on Occupational Performance

1. The seizure disorder and/or the anticonvulsive medications prescribed to control the seizures may affect the individuals alertness and learning potential. 2. the amount of brain damage incurred by the seizures and associated conditions and the effects of medication can influence all occupational performance areas.

Brain Stem// MEDULLA OBLONGATA

1. connects spinal cord with pons 2. contains relay nuclei of dorsal columns (gracilis and cuneatus);fibers cross to give rise to medial lemniscus 3. Inferior cerebellar peduncle relays dorsal spinocerebellar tract to cerebellum 4. Corticospinal tracts cross (decusssate) in pyramids 5. Medial longitudinal fasciculus arises from vestibular nuclei and extends throughout brain stem and upper cervical spinal cord; important for control of head movements and gaze stabilization (vestibulo-ocular reflex) 6. Olivary nuclear complex connects cerebellum to brain stem and is important for voluntary movement control 7. Contains several important cranial nerve nuclei: hypoglossal, dorsal nucleus of vagus, and vestibulocochlear 8. Contians important centers for vital functions: cardiac, respiratory, and vasomotor centers.

Spinal Cord Injury (SCI): Etiology

1. Trauma to the spinal cord as a result of compression shearing force, contusion secondary to motor vehicle accident, diving accident, penetration wound (gunshot or knife), sports injury, or fall. 2. Non-traumatic cord injuries may be a result of tumor, progressive degenerative disease.

Presenting Signs and Symptoms for Specific Classification of Seizures. -GENERALIZED SEIZURE: ABSENCE SEIZURES OR PETIT MAL SEIZURES

1. Typically occur between ages 4 and 12 years 2. A loos of consciouness without loss of muscle tone occurs 3. the child does not fall down, but does not recall the episode or any lapse in time.

Brain Stem// PONS

1. connects the medulla oblongata to the midbrain, allowing passage of important ascending and descending tracts 2. Anterior basal part acts as bridge to cerebellum (middle cerebellar peduncle) 3. Midline raphe nuclei project widely and are important for modulating pain and controlling arousal 4. Tegmentum contains several important cranial nerve nuclei: abducens, trigeminal, facial, vestibulocochlear.

Amyotrophic Lateral Sclerosis (ALS): Diagnosis

1. Usually clinical, with generalized motor involvement unaccompanied by sensory abnormalities 2. Electromyography can support the diagnosis 3. other processes such as spinal cord tumors and myopathies must be ruled out

Stroke/Cerebral Vascular Accident (CVA): Diagnosis

1. Usually diagnosed clinically using symptoms as a guide to lesion location 2. Infarction visualized via computerized axial tomography (CT) scan (may initally read as negative) 3. Arteriography 4. Positron emission tomography (PET) and single photon emission computerized tomography (SPECT) scanning to distinguish between infarct and noninfarct tissue 5. Magnetic resonance imaging (MRI) to rule out other conditions and screen for acute bleeding. 6. Diagnostic Testing 1. transcranial and carotid Doppler for noninvasive visualization of plaque or occlusion of the cerebral vessels 2. Electrocardiogram (ECG) to detect arrhythmias. 3. Echocardiography to evaluate presence of cardiac emboli and cardiac disease 4. Blood work to rule out metabolic abnormalities

Assessment of Chronic pain: Assess Degree of Suffering

1. Verbal complaints are out of proportion to degree of underlying pathology; incude emtional content 2. The person exhibits a stooped posture, antalgic gait. 3. The person exhibits facial grimacing

Spinocerebellar Degenerations

A group of degenerative disorders, characterized by progressive ataxia due to the degeneration of the cerbellum, brain stem, spinal cord, peripheral nerves, and the basal ganglia. These disorders are grouped as spinal ataxias, cerebellar ataxias, and multiple system degeneration.

Muscular Dystrophies/ Atrophies: Charcot-Marie-Tooth Disease

1. a disease involving the peripheral nerves marked by progressive weakness, primarily in peroneal (fibular) and distal leg muscles 2. typically occurs in the teenage years or earlier

Presenting Signs and Symptoms for Specific Classification of Seizures. PARTIAL FOCAL SEIZURE: SIMPLE PARTIAL SEIZURES

1. abnormal electrical impulses occur in a localized area of the brain, often in the motor strip of the frontal lobe 2. involuntary, repettitive jerking of the left hand and arm occurs, but the individual can maintain interaction with environment 3. may become generalized, and result in a loss of consciousness.

Post-Polio Syndrome (PPS): diagnosis

1. based on clinical symptoms 2. Characterized by the onset of new muscle weakness after years of stable functioning. 3. Disuse weakness should be ruled out

Assessment of Chronic pain: Assess for functional changes

1. check for self-imposed limited activity; disrupted lifestyle; disuse syndrom. 2. check for avoidance of work, home managament, leisure, social, and or sexual activity.

Presenting Signs and Symptoms for Specific Classification of Seizures. SELECTED SEIZURE SYNDROMES - LENNAX- GASTAUT SYNDROME

1. children with severe seizures, mental retardation, and a specific EEG pattern 2. Seisures of different types begin during the first three years of life and are difficult to control. 3. Associated with various brain disorders from structural abnormalities at birth asphyxia. 4. A regression of developmental status can occur in some cases

Myasthenia Gravis: Symptoms

1. common symptoms include ptosis, diplopia, muscle fatigue after exercise, dysarthria, dysphagia, and proximal limb weakness 2. Sensations and deep tendon reflexes are intact 3. Symptoms fluctuate over the course of the day 4. In relapsing periods, quadriparesis may develop. 5. Life threatening respiratory muscle involvement may occur.

Brain Stem// MIDBRAIN (mesencephalon)

1. conects pons to cerebrum; superior peduncle connects midbrain to cerebellum 2. contian cerebral peduncles (two lateral halves) each divided into anterior part or basis (crus cerebri and substantia nigra) and a posterior part (tegmentum) 3. tegmentum contains all ascending tracts and some descending tracts; the red nucleus receives fibers from the cerebellum, and is the orgin for the rubrospinal tract; important for coordination; contains cranial nerve nuclei: oculomotor and trochlear. 4. Substantia nigra is a large motor nucleus connecting with the basal ganglia and cortex; it is important in motor control and muscle tone 5. Superior colliculus is an important relay station for vision and visual reflexes; the inferior colliculus is an important relay station for hearing and auditory reflexes 6. Periaqueductal gray contains endorphin producing cells (important for the suppression of pain) and descending autonomic tracts)

BRAIN//Cerebral hemispheres (telenecephalon): Paired Hemispheres - LIMBIC SYSTEM

1. consists of the limbic lobe (cingulate parahippocampal, and subcallosal gyri) hipocampal formation, amygdaloid nucleus, hypothalamus, anterior nucleus of thalamus 2. Phylogenetically oldest part of the brain concerned with instincts and emotions contributing to preservation of the individual 3. Basic functions include feeding, aggression, emotions, and endocrine aspects of sexual response

Stroke/Cerebral Vascular Accident (CVA): Modifiable risk factors

1. hypertension. 2. Cardiac disease. 3. Atrial Fibrillation. 4. Diabetes Mellitus. 5. Smoking. 6. Alcohol abuse 7. Hyperlipidemia

Traumatic Brain Injury: Rancho Level of Cognitive Functioning - Level VI confused, appropriate: moderate assistance

1. inconsistently oriented to person, time, and place 2. able to attended to highly familiar tasks in non-distracting environment for 30 minutes with moderate redirection 3. Remote memory has more depth and detail than recent memory 4. Vague recognition of some staff 5. Able to use assistive memory aid with maximum assistance 6. Emerging awareness of appropriate response to self, family and basic needs 7. Moderate assistance to problem solve barriers to task completion 8. Supervised for old learning (self care) 9. Shows carry over for relearned familiar tasks (self care) 10. Maximum assistance for new learning with little or no carry over. 11. unawar of impairments, disabilities and safety risks 12. Consistently follows simple directions 13. Verbal expressions are appropriate in highly familiar and structured situations

Muscular Dystrophies/ Atrophies: Arthrogryposis Multiplex Congenita

1. it is detected at birth and associated with loss of anterior horn cells 2. Presence of weakness, deformities, and associated joint contractures 3. Position of rest for upper extremities tends to be internal rotation of the shoulders, extension of the elbows, and flexion of the wrists; for the lower extremities, there is flexion and internal rotation of the hips and clubfeet. 4. It may be stable, midly progressive, or may improve 5. Related problems include congenital heart defects, spinal defects, torticollis, and involvement of the diaphragm

Presenting Signs and Symptoms for Specific Classification of Seizures. - GENERALIZED SEIZURE: TONIC-CLONIC SEIZURES/GRAND MAL SEIZURES

1. most common type of seizure disorder in children 2. A brief warning/aura such as numbness, tast, smell or other sensation occurs. 3. Tonic phase includes a loss of consciousness, stiffening of th body, heavy and irregular breathing, drooling, skin pallor, and occasional bladar and bowel incontinence for a few seconds before the clonic phase begins. 4. Clonic phase includes alternating rigidity and relaxation of muscles. 5. postictal state follows the clonic phase and includes a period of drowsiness, disorentation or fatigue..

Presenting Signs and Symptoms for Specific Classification of Seizures. SIMPLE FRIBLE SEIZURE

1. most common type of seizure occuring in 5-10% of children under the age of 5, precipitated by a fever. 2. the seizure last less then 10 minutes and it includes jerking of a grand mal seizure 3. these seizures usually do not cause damage and they do not lead to epilepsy.

Amyotrophic Lateral Sclerosis (ALS): Symptoms

1. muscle weakness and atrophy, evidence of anterior horn cell destruction, often begins distally and asymmetrically. 2. Cramps and fsciculations precede weakness 3. Signs usually being in the hands 4. Lower motor neuron signs are soon accompanied by spasticity, hyperactive deep tenson reflexes, and evidence of corticospinal tract involvement. 5. Dysarthria and dysphagia are evident. 6. Sensory systems, eye movements, and urinary sphincters are often spared.

Post-Polio Syndrome (PPS): symptoms

1. new onset of weakness 2. Easily fatigued 3. muscle pain 4. Joint pain 5. Cold intolerance 6. Atrophy 7. Loss of functional skills

Cerebral Palsy (CP): Onset, prevelance, and prognosis

1. occurs in 1.5 to 2 per 1,000 births 2. Prognosis is dependent on the severity of the brain injury and the location 3. it is nonprogressive; however, deformities and contractures may develop depending on the level of involvement 4. It may be accompanied with seizure, intellectual and/or behavior disorders 5. The individual can have normal intelligence, hich is masked by significant motor deficits 6. An increase in the number of infants surviving prematurely and an increase in low birth weight have resulted in a higher incidence of the spastic diplegia type of CP

Chronic Pain.

1. pain that persists beyound the usual course of healing. 2. symptoms present for greater than 6 months for whcih an underlying pathology is no longer identifiable or may have never been present.

BRAIN//Cerebral hemispheres (telenecephalon): Paired Hemispheres - FRONTAL LOBE

1. precentral gyrus: primary motor cortex for voluntary muscle activation 2. Prefrontal cortex: controls emotions, judgements 3. Premotor cortex related to planning of movements including Broca's area: Controls aspects of speech

Sensory Processing Disorders: Sensory discrimination disorder (SDD)

1. visual 2. auditory 3. tactile 4. vestibular 5. proprioceptive 6. taste/smell

Peripheral Nervous System: how many cranial nerves are there?

12 pairs of cranial nerves, all nerves are distribued to head and neck except C.N. Xwhich is distributed to thorax and abdomen

Post-Polio Syndrome (PPS): Onset, prevalence, and prognosis

250,000 people live with post-polio syndrome. Onset is typically 15 years after recovery from polio Progress is slow with a good prognosis unless breathing or swallowing difficulties occur.

Howmany different segments is the spinal cord devided into?

30 segments Cervical - 8 Thoracic - 12 Lumbar - 5 Sacral - 5 * A few coccygeal segments

Trauma: Traumatic Brain Injury Glasgow Coma Scale: Best Verbal Response (V)

5- oriented (patient responds coherently and appropriately to questions such as the patients name and age, where they are and why, the year, month, etc.) 4- confused (patient responds to questions coherently but there is some disorientation and confusion) 3-Inappropriate words (random or exclamatory speech, but not conversational exchange) 2-Incomprehensible sounds (Moaning but no words) 1-None

Trauma: Traumatic Brain Injury Best Motor Response (M)

6-Obeys commands (the person does simple things as asked) 5-Localizes to pain (purposeful movements towards changing painful stimuli) 4-Withdraws from pain (pulls part of body away when pinched) 3-Flexion in response to pain (decorticate response) 2-Extension to pain (decerebate response) 1-No motor response

Brachial Plexus Disorder: Klumpke's Palsy

A paralysis of the lower brachial plexus including the seventh and eighth cervical and first throracic nerves. 1. Relatively rare when compared to the prevalence of Erb's Palsy 2. It results in paralysis of the hand and wrist, often with ipsilateral Horner's Syndrome (miosis, ptosys, and facial anhidrosis 3. Characteristic signs are that the hand is limp and the fingers do not move.

Brachial Plexus Disorder: Erb's palsy

A paralysis of the upper brachial plexus including the fifth and sixth cervical nerves; C7 may also be involved in some cases. 1. Muscles most often paralyed include the supraspinatus and infraspinatus as well as deltoid, biceps, brachialis, and subscapularis. 2. The arm cannot be raised, elbow flexion is weakened and weakness in retraction and protraction of scapula may be noted. 3. The arm grossly presents with the arm straight and wrist fully bent (the waiters tip position) 4. Positioning and ROM exercises are necessary to retain external rotation, abduction, and flexion at the shoulder as well as distal flexibility

Stroke/Cerebral Vascular Accident (CVA): what is a TIA

A transient ischemic attack (TIA) is a transitory stroke that lasts for only a few minutes 1. TIAs occur when the blood supply to part of the brain is briefly interrupted 2. TIA symptoms, which usually occur suddenly, are similar to those of stroke but do not last as long. Mos symptoms of a TIA disappear withn an hour, although they may persist for up to 24 hours 3. Symptoms can include: numbness or weakness in the face, arm, or leg, especially on one side of the body; confused or difficulty in talking or understaning speech; trouble seeing in one or both eyes; difficulty with walking, dizziness, and/or loss of balance and coordination 4. TIAs are often warning signs that a person is at risk for a more serious and debilitating stroke. About 1/3 of those who have a TIA will have an acute stroke some time in the future.

Spina Bifida: Medical Management Shunts

A ventriculoperitoneal or other type of shunt is indicated should the complication of hydrocephalus occur, in which the cerebral spinal fluid is not absorbed resulting in an increase in size of the ventricles of the infants head.

Seizure Disorders

Abnormal bursts of electricity interfere with normal brain function. 1. Are usually idiopathic; they can be hereditary. 2. Are often associated with conditions that involve scarring in the brain hemorrhage. - Severe head injuries or brain hemorrhage -Cerebal Palsy -Hydrocephalus -Metabolic disorders. -Infections, meningitis, encephalitis, congenital infections -Rubella

Peripheral Nervous System: Spinal Nerves Dorsal (posterior) Root

Afferent (sensory) fibers from sensory receptors from skin, joints, and muscles; each dorsal root possesses a dorsal root ganglion (cell bodies of sensory neurons); there is no dorsal root for C1

Neuropathic Pain: Herpes Zoster (shinglies):

An acure, painful mononeuropathy caused by the varicella-zoster virus. 1. characterized by vesicular eruption and marked inflammation of the posterior root ganglion of the affected spinal nerve or sensory ganglion of the cranial nerve; ventral root involvement (motor weakness) in 5%-10% if cases. 2. infection can last from 10 days to 5 weeks. 3. Pain may persist from months (post-herpetic neuralgia).

Huntington's Chorea

An autosomal dominant disorder 1. begins in middle age 2. onset of this disease process is insidious 3. Occus in 1 in 10,000 4. Characterized by choreiform movements and progressive intellectual deterioration 5. Psychiatric disturbance (personality chang, manic depressive symptoms, and schizophreniform illness) may preced the onset of the movement disorder.

Spinal Cord// White Matter

Anterior (ventral), lateral, and posterior (dorsal) white columns or funiculi. 1. Ascending fiber system (sensory pathways) 2. Descending fiber system (motor pathways)

Spinal Cord// White Matter - DESCENDING FIBER SYSTEM (motor pathways): CORTICOSPINAL TRACTS

Arise from primary motor cortex, descend in brain stem, cross in medulla (pyramidal decussation), via lateral corticospinal tract to ventral gray matter (anterior horn cells); 10% of fibers do not cross and travel in anterior corticospinal tract to cervical and upper thoracic segments; important for voluntary motor control

Spinal Cord// White Matter - DESCENDING FIBER SYSTEM (motor pathways): VESTIBULOSPINAL TRACTS

Arise from vestibular nucleus and descend to spinal cord in lateral (uncrossed) and medial (both crossed and uncrossed) vestibulospinal tracts; important for control of muscle tone, antigravity muscles, and postural reflexes

Spinal Cord// Autonomic Nervous System (ANS) Modulated by Brain Centers - DESCENDING AUTONOMIC SYSTEM

Arises from control centers in hypothalamus and lower brain stem (cardiac, respiratory, vasomotor) and projects to preganglionic ANS segments in thoracolumbar (sympathetic) and craniosacral (parasympathetic) segments

Spinal Cord// White Matter - DESCENDING FIBER SYSTEM (motor pathways): TECTOSPINAL TRACT

Arises from superior colliculus (midbrain) and descends to ventral gray; assists in head turning responses in response to visual stimuli

Spinal Cord// White Matter - DESCENDING FIBER SYSTEM (motor pathways): RUBROSPINAL TRACT

Arises in contralateral red nucleus and descends in lateral white columns to spinal gray; assists in motor function

Spinal Cord// White Matter - DESCENDING FIBER SYSTEM (motor pathways): RETICULOSPINAL SYSTEM

Arises in the reticular formation of the brain stem and descends (both crossed and uncrossed) in both ventral and lateral columns, terminates both on dorsal gray (modifies transmission of sensation, especially pain) and on ventral gray (influences gamma motor neurons and spinal reflexes)

Spina Bifida: Brain damage

As a result of increased intracranial pressure can cause mental retardation.

Stroke/Cerebral Vascular Accident (CVA): CEREBRAL HEMORRHAGE

Bleed secondry to hypertension or aneurysm

CNS Support Structures// Blood supply

Brain is 2% of body weight with a circulation of 18% of total blood volume 1. Carotid System 2. Vertebrobasilar System 3. Circle of Willis 4. Venous Drainage

Spinal Cord Injury (SCI): Clinical Syndromes ANTERIOR CORD

Caused by flexion injuries; motor function, pain, and temperature sensations are lost bilaterally below the lesion

Stroke/Cerebral Vascular Accident (CVA): CEREBRAL INFARCTION

Due to either embolism or thrombosis of an intra or extracranial arteries

Cerebellar/Spinocerebellar Disorders

Charcterized by ataxia, dysmetria, dysdiadochokinesia, hypotonia, movement decompositon tremor, dysarthria, and nystagmus.

Damage to the Temporal Lobe would result in the need to...

Communicate Nonverbally

Spinal Cord// Autonomic Nervous System (ANS) - PARASYMPATHETIC (craniosacral) DIVISION

Conserves and restores homeostasis; slows heart rate and reduces blood pressure, increases peristalsis and glandular activity

BRAIN//Cerebral hemispheres (telenecephalon): Paired Hemispheres

Consisting of 6 lobes on each side: 1. Frontal 2. Parietal 3. Temporal 4. Occipital 5. Insular 6. Limbic

Spinal Cord// Central Gray Matter

Contains 2 anterior (ventral) and 2 posterior (dorsal) horns united by gray commissure with central canal 1. Anterior horns contian cell bodies that give rise to efferent (motor) neurons: alpha motor neurons to effect muscles and gamma motor neurons to muscle spindles 2. Posterior horns contain afferent (sensory) neurons with cell bodies located in the dorsal root ganglia 3. Two enlargements, cervical and lumbosacral, for origins of nerves of upper and lower extremities 4. Lateral horn is found in thoracic and upper lumbar segments for preganglionic fibers of the autonomic nervous system

Neuropathic Pain: Talamic pain

Continuous, intense pain occurring on the contralateral hemiplegic side; the result of a stroke involving the ventral posterolateral thalamus, poor rehabilitation potential.

Spinal Cord// White Matter - ASCENDING FIBER SYSTEM (sensory pathway): SPINORETICULAR TRACTS

Convey deep and chronic pain to reticular formation of brain stem via diffuse, polysynaptic pathways

Spinal Cord// White Matter - ASCENDING FIBER SYSTEM (sensory pathway): SPINOCEREBELLAR TRACTS

Convey proprioception information from muscle spindles, Golgi tendon organs, touch, and pressure recptors to cerebellum for control of voluntary movements; dorsal spinocerebellar tract ascends to contralateral and ipsilateral superior cerebellar peduncle

Spinal Cord// White Matter - ASCENDING FIBER SYSTEM (sensory pathway):SPINOTHALAMIC TRACTS

Convey sensations of pain and temperature (lateral spinothalamic tract), and crude touch (anterior spinothalamic tract); tracts ascend 1 or 2 ipsilateral spinal cord segments (Lissauer's tract), synapse and cross in spinal cord to opposite side and ascend in ventrolateral spinothalamic system

Spinal Cord// White Matter - ASCENDING FIBER SYSTEM (sensory pathway): DORSAL COLUMNS/MEDIAL LEMNISCAL SYSTEM

Convey sensations of proprioception, vibration, and tactile discrimination; divided into fasciculus cuneatus (upper extremity tracts, laterally located) and fasciculus gracilis (lower extremity tracts, medially located); neurons ascend to medulla where fibers cross (lemniscal decussation) to form medial lemniscus, ascend to thalamus and then to somatosensory cortext.

Trauma: Traumatic Brain Injury

Damage results from penetration of the skull or from rapid acceleration or deceleration of the brain. 1. Injury occurs in the tissue at the point of impact (coup) , at the opposite pole (contrecoup), and diffusely along the frontal and temporal lobes. 2. Injury can result from a variety of occurrences: -Skull fractures -Closed head injuries -Penetrating wounds of the skull and brain -traumatic injury to extracranial blood vessels -Nerve tissues, blood vessels, and meninges are sheared, torn, or ruptured, resulting in hemorrhage, edema, and ischemia

BRAIN//Cerebral hemispheres (telenecephalon): Paired Hemispheres - INSULA

Deep within lateral sulcus, associated with visceral functions

Spinal Cord Injury (SCI): Classification of injury/signs and symptoms

Degreee of impairment and severity of injury is graded using the ASIA Impairment Scale: 1. A=Complete, no sensory or motor function is preserved in the sacral segments S4-S5 2. B=Incomplete, sensory but no motor function is preserved in the sacral segments S4-S5 3. C= Incomplete, motor function is preserved below the neurological level, and the majority of key muscle groups below the neurological level have a muscle grade of less thean 3/5 4. D= Incomplete, motor function is preserved below the neurological level, and the majority of key muscle groups below the level have a muscle grade greater then or equal to 3/5 5. E = Normal, sensory and motor function are normal

Ataxia

Describes a lack of coordination while performing voluntary movements. It may appear as clumsiness, inaccuracy, or instability. Movements are not smooth and may appear disjointed or jerky.

Overview of Occupational Therapy Evaluation and Intervention for Neurological System Disorders: Evaluation of client factors and performance skills

Determine sesory and motor dysfunction and strengths. 1. Extent of paralysis/weakness 2. Severity and distribution of spasticity 3. Gross and fine motor coordination loss 4. Evaluation of sensory modalities: light touch, pain, pressur, proprioception, kinesthesia, temperature, gustatory, olfactory, auditory. 5. Postural control evaluation 6. ROM testing 7.MMT 8. Skin Integrity Determine cognitive/perceptual dysfunction and strengths. 1. Evaluation of foundation visual skills; acuity, visual field, ocular range of motion, accommodation, pursuits, saccades 2. Evaluation of pervasive impairments: decreased arousal, decreased alertness, loss of selective/sustained attention, concrete thinking, decreased insight, impaired judgment, confusion, disorientation, language dysfunction, impaired motivation, and impaired initiative Determine psychosocial dysfunction and strengths 1. Evaluation of emotional/affective disturbances: lability, euphoria, apathy, depession, aggession, irritability, frustration tolerance. 2. Coping Mechanisms 3. Adaptation to change in occupational role functioning or to difficulty in assuming occupational roles.

Spina Bifida Early identification of symptoms

Early identification is vital, as these conditions are life threatening 1. immediate notification of signs and symptoms to the child's/facility's neurosurgeon is required 2. Blocked shunts are revised by removin the blocked section and replacing it with a catheter. 3. Infections are treated by with drawing fluid through or replacing the tubing. Intravenous antibiotics are also administered 4. Medications to reduce cerebrospinal fluid production and intra-cranial pressure are sometimes used as an interim measure. 5. Urological management, and if indicated intermittent catheterization 6. Orthopedic management for motor deficits

Guillain-Barre Syndrome

Etiology is unknown. May occur after an infectious disorder, surgery, or an immunization. Onset, prevalence, and prognosis: Affects both sexes at any age; onset of recovery is 2-4 weeks after first symptoms; long term prognosis: 1. 50% exhibit mild neurological deficits 2. 15% exhibit residual functional deficits 3. 80% are ambulatory in 6 months 4 5% die of complications

Spinal Cord Injury (SCI): Clinical Syndromes BROWN-SEQUARD

Hemi-section of the cord resulting in ipsilateral spastic paralysis, ipsilateral loss of position sense, ipsilateral loss of discrimitive touch, contralateral loss of pain, and contralateral loss of thermal sense

Assessment of Chronic pain: physical examination

Identification of underlying pathology (cause of pain); objective physical finding are usually not readily identified. 1. Assess all symptoms: musculoskeletal, neurologic, and cardiopulmonay. Check for muscle guarding 2. Check for postual stress syndrom (PSS): chronic muscle lengthening and/or shortening that causes postural malalignment and stress to soft tissues. 3. Check for movement adaptation syndrome (MAS): habituated movement dysfunction. 4. Check for autonomic changes (sympathetic activity): typically present iwht acute pain but not with chronic pain. 5. Assess for abnormal movements.

Creatine Kinase (CK)

In muscular dystrophies blood tests demonstating a highly elevated level of ____________________ provide a differential diagnosis to congenital myopathies in which levels of _____________ are normal or just slightly elevated.

CNS Support Structures// Blood supply VENOUS DRAINAGE

Includes cerebral veins, dural venous sinuses

Structural Cerebellar Lesions

Includes vascular lesions (stroke) and tumor deposits, producing symptoms and signs appropriate to their locus within the cerebellum 1. demyelinating plaques of mutiple sclerosis may also arise in the cerebellum white matter and give rise to cerebellar symptoms. 2. Alcoholism and nutritional deprivation can cause degeneration of the vermis and anterior cerebellum.

Neuron Function: Neuronal Signaling ACTION POTENTIAL:

Increased permeability of Na+ and influx into cell with outflow of K+ results in polarity changes (inside to about +35mV) and depolarization; generation of an action potential is all-or-none

Spina Bifida: Arnold Chiari Syndrome

Increased pressure may also result in ___________________ in which a portion of the cerebellum and medulla oblongata slip down through the foramen magnum to the cervical spinal cord.

Spinal Cord Injury (SCI): Clinical Syndromes CAUDA EQUINA SYNDROME

Injury at the L1 level and below resulting in lower motor neuron lesion, flaccid paralysis with no spinal reflex activity

Spinal Cord Injury (SCI): Clinical Syndromes CONUS MEDULLARIS

Injury of the sacral cord and lumbar nerve roots resulting in lower extremity motor and sensory loss and a reflexic bowel and bladder

Dyskinesias

Involuntary, nonrepetitive, but occasionally stereotyped movements affecting distal, proximal, and axial musculature, in varying combinations. Most are representative of basal ganglia disorders

Brain// Diencephalon - SUBTHALAMUS

Involved and controls the functions of the autonomic nervous system and the neuroendocrine system

Duchenne Muscular dystrophy

Is due to an absent muscle protein product, dystrophin

Neuron Function: Neuronal Signaling CONDUCTION VELOCITY

Is proportional to axon diameter; the largest myelinated fibers conduct the fastest.

Nerve Fiber types: A Fibers

Large, myelinated, fast conducting 1. Alpha: proprioception, somatic motor. 2. Beta: touch, pressure 3. Gamma: motor to muscle spindles 4. Delta: pain, temperature, touch

What is the function of neurons?

Neuronal Signaling

What is Neuropathic pain and the different types?

Pain as a result of lesion in some part of the nervous system (central or peripheral); usually accompanied by some degree of sensory deficit. 1. Thalamic pain 2. Complex regional Pain syndrome Type I (formerly known as reflex sympathetic dystrophy RSD) 3. Disorders of peripheral roots and nerves 4. Herpes Zoster (shingles) 5. Phantom limb pain 6. Musculoskeletal pain 7. Psychosomatic pain 8. Headache and craniofacial pain 9. Referred pain.

Neuron Function: Neuronal Signaling RESTING MEMBRANE POTENTIAL

Positive on outside, negative on inside (about -70mV)

Sensory Processing Disorders: Medical Management

Possible pharmacology intervention to decrease activity level.

Spinal Cord// Autonomic Nervous System (ANS) - SYMPATHETIC (thoracolumbar) DIVISION

Prepares body for fight or flight, emergency responses, raises heart rate and blood pressure, constricts peripheral blood vessels and redistributes blood; inhibits peristalsis

Peripheral Nervous System: Spinal Nerves DERMATOME

Refers to the skeletal muscles innervated by motor axons in a given spinal root

Peripheral Nervous System: Spinal Nerves MYOTOME

Refers to the skeletal muscles innervated by motor axons in a given spinal root

Brachial Plexus Disorder blanks (Plexus, plexus)

Secondary to traction during birth, invasion of metastatic cancer, after radiation treatment secondary to fibrosis, or traction injury. Symptoms: 1. mixed motor and sensory disorders of the corresponding limb 2. Rostral injuries produce shoulder dysfunction while caudal injuries produce dysfunciton in the hand. Diagnosis: 1. Made via CT scanning of the ________ in cases where a mass is present 2. EMG/ nerve conduction velocities are used to localize the _______ lesion

What 3 components make up Neurons structure?

Structure can vary in size and complexity 1. Cell bodies: (genetic center) with dendrites (receptive surface area to receive information via synapses) 2. Axons conduct impulses away from the cell body (one way conduction) 3. Synapses allow communication between neurons; chemical neurotransmitters are released (chemical synapses) or electrical signals pass directly from cell to cell (electrical synapses)

Myasthenia Gravis

The disease is caused by an autoimmune attack on the acetylchoine recptor of the postsynaptic neuromuscular junction. 1. this process is considered a disorder of neuromuscular transmission 2. The initiating even leading to antibody production is unkown Onset, Prevalence, and prognosis 1. Occurs at any age but most often affects younger women and older men. 2. Occurs in 14 per 100,000 3. Prognosis varies, but usually is a progressive disabiling process 4. Death may occur from respiratory complications

Cerebral Palsy (CP): Diagnosis - Classification

The distribution of the disorder in limbs determines the classification: 1. Monoplegia involves one extremity 2. Hemiplegia involves upper and lower extremity on the same side 3. Paraplegia involves the lower extremities 4. Quadriplegia involves all extremities 5. Diplegia involves less uppper extremity involvement and greater lower extremity functional impairment.

Demyelinating Disease: Multiple Sclerosis (MS)

The exact cause is unknown. 1. the myelin damage is probably mediated by the immune system 2. postulated etiologies include infection by a slow or latent virus and the possibility of environmental factors contributing to the disease.

Cerebral Palsy (CP): Diagnosis - Different types of Lesions.

The location and severity of the lesion determines the type of cerebral palsy: 1. Motor Cortex 2. Basal Ganglia 3. Cerebellum

Muscular Dystrophies/ Atrophies: Duchenne's Muscular dystrophy

The most common form of muscular dystrophy 1. It is detected between two and six years of age. 2. It is inherited, sex-linked and recessive occurring in males 1 per 3,500 births 3. Symptoms include elargement of calf musles and at times enlargement of the forearm and thigh muscles giving an appearance the child is healthy. (this enlargement is due to fibrosis and formation of adipose tissues, which cause weakness. It is known as pseudohypertrophy) 4. Weakness of the proximal joints progresses to the point that the child has to crawl up his thighs with his hands to stand from a kneeling position known as Gower's sign 5. Weakness occurs in all voluntary muscles, including the heart and diaphragm. 6. individuals rarely survive beyound their early 20s due to respiratory problems, infections, and/or cardiovascular complications

Pain

The sensory and emotional experience associated with actual or potential tissue damage.

Peripheral Nervous System: Spinal Nerves Where do nerve roots exit from?

The vertebral column through intervertebral foramina 1. In cervical spine, numbered roots exit above the corresponding vertebral body, with C8 exiting below C7 and above T1 2. In the thoracic and lumbar segments, the roots exit below the corresponding vertebral body

Spina Bifida Meningocele: symptoms

Usually does not present with symptoms impacting on function as the spinal cord itself is not entrapped. - Occasionally slight instability and neuromuscular impairments, such as mild gait involvement and bowel or bladder problems may occur.

BRAIN//Cerebral hemispheres (telenecephalon): WHITE MATTER

myelinated nerve fibers located centrally 1. transverse (commissural) fibers: interconnect the two hemispheres, including the corpus callosum (the larges), anterior commissure, and hippocampal commissure 2. projection fibers: Connect cerebral hemispheres with other portions of the brain and spinal cord 3. Association fibers: connect different potions of the cerebral hemispheres, allowing cotext to function as an integrated whole.

Neuropathic Pain: referred pain

pain arising from deep visceral tissues that is felt in a body region remote from the site of pathology, resutling in tenderness and cutaneous hyperalgesia (medial left arm pain with heart attack; right subscapular pain from gallbladder attack)

Neuropathic Pain: Phantom limb pain

pain in a limb following amuputation of that limb; differentiated from far more common phantom limb sensations

Neuropathic Pain: Complex Regional pain syndrome type I (formerly known as reflex sympathetic dystrophy RSD)

pain maintained by efferent activity of sympathetic nervous system. 1. characterized by abnormal burning pain (causalgia), hypersensitivity to light touch, and sympathetic hyperfunction (coldness, sweating, etc) 2. Usually associated with traumatic injury.

Stroke/Cerebral Vascular Accident (CVA): Symptoms VERTEBROBASILAR SYSTEM

results in pseudobulbar signs (dysarthria, dysphagia, emotional instability), tetraplegia

Spina Bifida with Myelomeningocele: symptoms

results in sensory and motor deficits occurring below the level of the lesion, and may result in lower extremity paralysis and/or deformities, and bowel and bladder incontinence. 1. the level of the lesion impact leg movements 2. lesions of S2-S4 results in bladder and bowel problems - a neurogenic bladderimpacts on the sensation to urinate and the control of the urinary sphincter - Incomplete emptying of the bladder results; this often leads to infections - A neurogenic bowel causes constipation and incontinence

Neuropathic Pain: Headache and craniofacial pain

temporomandibular joint syndrome (TMJ)

Neuropathic Pain: psychosomatic pain

the origin of the pain experience is due to mental or emotional disorders.

CNS Support Structures// Blood -brain barrier

the selective restriction of blood borne subtances from entering the CNS; associated with capillary endothelial cells