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264 Cards in this Set
- Front
- Back
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cutaneous receptors that respond to pressure (2)
slow or fast adapting? nerve type? |
Ruffini , Merkel discs
slow a-beta |
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cutaneous receptors that respond to touch and vibration?
slow or fast adapting? nerve type? |
Pacinian, Meissner
fast A-beta |
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which are in the deep dermis?
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ruffini and pacinian
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which is in superficial dermis, esp finger pads?
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meissner
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which is in the epidermis?
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merkel discs
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muscle spindles--
1a goes to: ____ and _____ adapting II goes to: ____ and _____ adapting |
chain and bag ; fast
chain only, slow |
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dynamic gamma bias increases the sensitivity of the ___
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bag only
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1b = _______ =______ adapting
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GTO ; slow
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1a's are sensitive to _______ (phasic) & ______(tonic)
II's are sensitive to ______ (tonic) |
velocity & length
length only |
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when are the spindles silent?
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contraction
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when are the GTOs silent?
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stretch
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which joint receptor senses--
stretch @ extreme ROM? compression/hydrostatic changes? pressure @ extreme ROM? noxious stimuli? |
ruffini I
pacinian II golgi III free IV |
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4 distinct types of sensation?
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pain, fine touch, temperature, proprioception
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what is a dermatome?
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area of skin inn by one dorsal root (cell bodies and their axons)
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what is a bundle of axons with the same origin and a common termination?
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tract
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for crude awareness, info must make it to the:
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thalamus
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for full awareness, must make it to the ____
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cortex
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3 types of sensory pathways
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conscious relay
divergent unconscious |
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a- alpha neurons, proprioceptive neurons: __ & ___
a-beta neurons, discriminative touch: ____ |
1a & 1b
II |
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what tract at group 1 & group II in?
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DC/ML
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what tract are a-delta and C fibers in?
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spinothalamic
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1st order neuron of DC/ML enters ______ to ______tract and acends the spinal cord to the ______, where it synpses on the 2nd order neuron then crosses midline and ascends to the ____ thru the ________ in the ____ medulla
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medial to Lissauer's
medulla VPL, medial lemniscus, upper |
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fasciulus gracilis in the spinal cord = info from ____
faciculus cuneatus in the SC = info from _____ |
legs- medial
arms - lateral |
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thalamocortical afferents travel through the ______ to get to the ______, which is located where?
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internal capsule
primary somatosensory cortex post-central gyrus |
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primary sensory cortex = area's ___&___&_____
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3A/3b, 2, 1
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info from 3a,3b,1 integrated by ____, resulting in your ability to perform _______
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2
astereognosia |
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does area 2 cross body parts?
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no
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which area crosses body parts to help you build a representation of your whole body?
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5
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which area integrates info from your environment?
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7
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areas 5 & 7 are " _____" areas
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parietal association
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damage to the R or L areas 5 & 7 produces severe neglect?
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R damage - L neglect
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where does information from the face join in for the DC/ML?
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pons
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where does the antero-lateral 2nd order neuron decussate?
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level of the spinal cord
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fast pain - _____ fibers
slow pain-______ fibers |
a-delta
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1st order AL fibers enter _____tract and synapse in (2) places
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lissauers
substantia gelatinosa (I & II) body of the dorsal horn (III &IV) |
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diverging pathways include _____pain
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slow
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what fibers synpase on clark's nucleus or the nucleus dorsalis?
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leg fibers entering from lumbar/sacaral segments
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is there some mixing of info in the somatosensory pathways?
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yes
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what is perception?
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interpretation of sensation
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what system are the internal arcuate fibers a part of?
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DC/ML - midline crossing in medulla before they turn into medial lemniscus
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AL system- name of structure in which the fibers cross midline?
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anterior white commissure
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if a person has a lesion in the VPL nucleus, what aspects of pain will be known to the person?
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inability to localize, but emotional aspects remain
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which pathway is associated ONLY with pain
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spinolimbic
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the periaqueductal gray is a part of what system?
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descending pain control
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what 2 brain structures might be removed to make pain less bothersome even though the intensity would be the same?
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anterior cingulate gyrus and posterior insula
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what lobe are motor planning areas in?
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frontal
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where are "control circuits" for movement?
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cerebellum and BG
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Is a cranial n a UMN or LMN? where do the cranial nn originate?
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LMN, brainstem
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what is an alpha motor neuron and the mm fibers it innervates?
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motor unit
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what determines if a mm is slow twitch or fast twitch?
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neuron that inn. it
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slow or fast have smaller diameter?
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slow
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what happens when a motor neuron is activated?
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release ACh
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what prinicple says recruitment happens from smaller to larger alpha motor neurons
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henneman's size principle
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why are slow twitch usually activated first?
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smaller cell bodies depolarize first
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for very precise control, do you want a large motor unit or a small motor unit?
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small
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GTOs and mm spindles modulate _____
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alpha output
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during most movements do the alpha and gamma motor neurons fire simultaneously?
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yes, this is called alpha-gamma coactivation and allows the body to provide proprioceptive info at all times
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reflex must have a ___ & _______ component
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sensory & motor
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what is group of cell bodies in the spinal cord whose axons project to a single mm?
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motor neuron pool
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what mm do the following motor neuron pool inn-
medial: lateral: anterior: posterior: |
axial & proximal
distal extensors flexors |
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motor control term describing coordinated activation of mm groups
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mm synergies
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where are CPGs located?
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lumbar cord
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is a CPG adaptable?
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yes
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do you need one CPG or 2 CPGs for locomotion?
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cycles of 2 CPGs
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decision to walk activates _____ , which activates ______, which activates ____
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Mesencephalic region, descending motor pathways to the lumbar cord, CPGs
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does normal walking need supraspinal control?
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yes!
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intrinsic oscillation in spinal interneurons generates the ______ ; spinal networks used for flexor withdrawal and reciprocal inhibition _____ the rhythm (pattern generator)
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rhythm (rhythmn generator)
distribute |
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how to influence CPGs?
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sensory input
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can learning occur at a spinal cord level?
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yes--
example: preserved stumbling corrective responses in transected cats |
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deep tendon reflex is an example of a ________
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monosynaptic stretch reflex aka a Ia phasic stretch reflex
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what happens at the same time at the monosynaptic stretch reflex?
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reciprocal inhibition of the antagonist via disynaptic inhibition thru Ia-IN
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disynaptic (tonic) stretch reflexes are modulated by group ___s
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II
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when is the only time a tonic stretch reflex would be noticed clinically?
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following UMN lesion
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monosynaptic reflex is excitatory to ____ & ___
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homonymous motoneurons and synergists
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why is disynaptic stretch reflex noticed in UMN lesion?
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descending input no longer inhibiting the tonic reflex
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the effect of GTO autogenic inhibition via disynaptic inhibition Ib-IN is to....
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allow mm to relax at rest
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WB GTO is _____
NWB GTO is ____ |
excitatory
inhibitory |
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flexor withdrawal with crossed extension results from ____ activation
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a delta
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which joint receptors appear to inihibit mm around a jt, esp in the presence of inflammation?
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golgi-mazzoni
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why perform stretching slowly?
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less likely to cause a stretch reflex
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to facilitate a mm that is already contracting, use a ______ to increase contraction through _______
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quick stretch ; autogenic facilitation
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what mechanism is used for contract-relax stretching
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GTO
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what reflex is monosynaptic and elicited by electrically exciting a m?
hint: used diagnostically |
H-reflex
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can spinal cord reflexes be generated by MS or cutaneous receptors?
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yes
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cutaneous stimulation: facilitory to mm under stimulated area via group _____ disynaptic interneurons
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II
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name the neurotransmitter assoc with each system:
raphespinal cerulospinal |
serotonin
noradrenaline |
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once corticospinal axons leave pyramidal cells, they travel first through _______, then form the _____ in the midbrain and pons, then come together as the ______ in the _______. where do almost all decussate?
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posterior limb of the internal capsule ; cerebral peduncles, pyramids in the medulla ;
in the lower medulla |
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think hula hooping and push-ups--this system prepares the body to do these activities
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medial corticospinal
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this tract has strong projections to shape the hand (wrist extensors) but not to the fingers
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rubrospinal
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which 2 tracts are activated when anxiety is high and decrease motor performance because they are nonspecific
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raphespinal and cerulospinal
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is polio an UMN or LMN lesion?
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LMN
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what is it called when a single motor unit twitches?
LMN or UMN? |
fasciculation
LMN |
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what are brief, contractions of a m or group of mm -- ex hiccups
EX of a disease |
myoclonus
HD |
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what are brief contractions of mm fibers that are always pathologic and cannot be seen without EMG
LMN or UMN? |
fibrillations
almost always LMN |
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when would flaccidity be seen in an UMN lesion?
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acutely
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velocity-dependent resistance and hyperreflexia
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spasticity
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non velocity dependent resistance
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rigidity
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rigidity that occurs if a severe lesion in the midbrain occurs
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decerebrate
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rigidity with severe lesion above the midbrain
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decorticate
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typically, in an UMN, ______ but not _____ of mm occurs. however, ________ occurs that is independent of work done
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paresis but not paralysis
fatigue |
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babinski and hoffman's indicate _____ damage
both are associated with an abnormal _____ pattern in response to an innoculous stimulus |
corticospinal
flexion |
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is sustained clonus always pathologic?
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yes
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clasped knife response is assoc with UMN or LMN lesion? which type of afferents are responsbile?
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UMN
type II |
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ASHWORTH SCALE
0 1 1+ 2 3 4 |
0- no increase in tone
1- slight increase, catch @ end range 1+-slight increase, catch and minimal resistance through less than 1/2 to end 2- increase through ROM but easily moved 3- considerable increase in tone, passive movement is difficult 4- rigid in flexion or ext |
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MS is LMN or UMN?
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UMN lesions cause fatigue!
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visceral information from cranial nerves VII, IX, X sent to the ______ of the _____
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solitary nucleus of the medulla
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in the ANS system, preganglionics release:
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ACh
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sympathetic preganglionics are at what levels of the SC?
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T1-L2
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adrenergic means what (2) transmittersbind to them
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NE and epinephrine
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alpha blockers decrease BP via
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vasodilation
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beta 2 agonists prevent:
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airway constriction
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beta-1 blockers decrease (2)
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HR and contractility
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pupil dilation occurs via ______ and constriction occurs via ______
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sympathetic
parasympathetic |
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horner's syndrome occur when _______ innervation to the head is disrupted
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sympathetic
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SS of horner's syndrome? (4)
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drooping eyelid
pupil constriction skin vasodilation absence of sweating |
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what can cause horners?
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stellate ganglion block
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vasovagal attack causes syncope d/t (2)
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decreased HR and vasodilation
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are corticobulbar fibers LMNs or UMNs?
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UMNs
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does the olfactory n go through the thalamus?
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no
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VISION
where does decussation occur? |
optic chiasm
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should the jaw jerk reflex be apparent or absent in a normal person?
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absent
if present, indicates UMN lesion of trigeminal n |
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salivation and crying are produced by the same n responsible for the expressions you make. name the CN
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facial
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hemi-facial paralysis = _____ n.
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facial n
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lower facial weakness on the contralateral side assoc with ______ lesion
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corticobulbar lesion
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main parasympathetic output comes from ____
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vagus
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test CN IX and X via____
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gag reflex
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which CN is important for breathing control in high SCI
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XI
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if the L hypglossal n is damaged, which way will the tongue deviate?
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L
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which CNs are mixed?
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V VII IX X
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what m does the trochlear n innervate and so what actions does it cause
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superior oblique
rotates eye medial and down |
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if the eye is deviated medially and horizontal gaze deficits are present, suspect what CN?
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ABDUCENS
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suspect what CN if the pt states trouble reading and looking downstairs?
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trochlear n
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where does explicit learning occur?
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medial temporal lobes
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4 examples of places where implicit learning occurs?
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cerebellum, BG, SMA, PMA
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3 stages of motor learning
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cognitive, associative, autonomous
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are nociceptors present in the brain?
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no
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are a-delta fibers myelinated?
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yes--this is what makes them "fast"
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are c fibers myelinated?
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no-- this is what makes them "slow"
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speed of axons--
1.LMN (1a and 1b) 2. a-beta 3. a delta 4. c |
1. 60-80 m/s
2. 30-40m/s 3. 15 m/s 4. 1 m/s |
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definition: increased sensitivity to painful stimuli
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hyperalgesia
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definitions: reduced or absent sensitivity to painful stimuli
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analgesia
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definition: stimuli that would normally not be painful activated nociceptors or activated pain pathways when it should not
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allodynia
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activated nociceptors release substances into tissues that tend to increae sensitivity to nociception- aka a _____ feedback loop ; name (3)
which one is more local and which 2 mediate central pathways? |
positive
histamine, glutamate, substance P histamine glutament & substance P |
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which irritant is released from mast cells d/t substance P?
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histamine
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as a LT consequence of cell breakdown, ______ degrades special extracellular proteins and ________degrades lipids
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bradykinins
prostaglandins |
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what do ruptured cells release which leads to nociceptor activation in the first place?
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K+ and ATP
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how does substance P cause edema?
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increases permeability of venuoles
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substance P acts directly and indirectly?
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yes
direct- increase sensitivity of nociceptors indirect: makes mast cells release histamine and causes edema |
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is the pain system specific or non-specific?
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non-specific
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intense over-activation of any sensory receptor can feel like pain?
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yes
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counterirritant mechanism: mechanoreceptors synapse on interneurons that release __________ onto ______fibers to reduce transmission
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enkephalin
Cfibers |
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main center for pain modulation?
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PAG
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where to inputs to the PAG come from?
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ascending pathways, hypothalamus, limbic
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output of the PAG tend to increase of inhibit pain transmission?
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inhibit
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nucleus raphe magnus releases _____ into the ______ to reduce pain transmission
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serotonin into the SC
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are opiate receptors located peripherally or centrally?
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both
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name 2 endogenous opiates (aka endorphins)
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dynorphin
metenkephalin |
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5 Mechanisms of Chronic Pain (con't on next slide)
1. injured nn fire spontaneously and erratically 2. injured nn release irritants that activate unmyelinated nn (pain) 3. 2nd & 3rd order keep firing even tho 1st order isn't |
1. ectopic foci
2. ephatic transmission 3. central sensitization |
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con't from previous slide
4. pathways adapt and alter such that pain is an inevitable part of the pathway 5. impaired ability for central structures to play their normal role |
4. structural reorganization
5. altered top-down |
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4 ways to avoid chronic pain
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1. prevent prolonged or intense pain
2. encourage normal sensorimotor behavior 3. holistic care 4. wean as quick as possible to let natural system take over! |
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medial reticulospinal tract motor outputs:
excites ipsilateral _____ and contralateral______ |
flexors
extensors |
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which tract do you utilize to make a deliberate shift of your head/eyes?
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tectospinal
**coordination of gaze |
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which tract does your body utilize to make an automatic adjustment?
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medial vestibulospinal
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why do some corticospinal fibers terminate in the dorsal horn?
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help with control of reflexes
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are all corticospinal fibers generated in the primary motor cortex?
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no!
also in PMA, SMA, CMA |
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which tract targets excitation of "anti-gravity" mm aka extensors?
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lateral vestibulospinal
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most corticospinal outputs are targeted on (2)
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1. interneurons near motoneurons
2. motoneurons for distal control (monosynaptic corticomotoneuronal connections) |
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which layer of the cortex do corticospinal fibers originate?
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layer 5
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after leaving the pyramids, the corticospinal tract travels in the ______
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lateral funniculus
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motor learning requires 3 things
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objective, practice, FB
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best way to cue proximal mm?
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visualize a task that would naturally engage the mm
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pyramidal cell layers deal with_____
granule cell layers deal with ____ |
output
input |
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flow of visual information--
what is the function of the dorsal stream vs the ventral stream? |
dorsal- where it is ; directly used in motor planning
ventral- what it is ; forms context that drives manipulation |
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where is area 4 and what is in it?
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precentral gyrus - M1
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describe the 2 parts of area 6 and their functions/where they are
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SMA- medial superior frontal gyrus- internally guided
PM-lateral- externally guided |
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what does the cingulate motor area contribute?
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motivational and emotional aspects
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2 tracts that emanate from M1
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corticospinal and corticobulbar
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can intensive trng change location and amount of cortex from which movement of a given body part can be elicited by e-stim?
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yes-this is called cortical plasticity
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which lamina is the primary motor pool?
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IX
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when is M1 active?
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during performance
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are any M1 cells active during planning?
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few
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PM or SMA more active with mental rehearsal?
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SMA
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what structure and 2 areas is PMA assoc. strongly with?
|
cerebellum ; 5&7
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PMA links _____ with______
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anticipatory postural responses into skilled performance
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is motor speech in PMA or SMA?
|
SMA
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SMA is heavily involved in _______ coordination and interconnected with the ______
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bimanual
BG |
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pre-SMA vs SMA?
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selection and strategy vs plannin and performance
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mental rehearsal activates ______ ONLY
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SMA
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6 cortical outputs
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1. SC via corticospinal tracts
2. brainstem 3. BG 4. cerebellum via pontine nuclei 5. thalamus 6. other cortical areas |
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corticobulbar pathways connected with the inferior olivary nucleus are used for _______ and motor learning
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error detection
|
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which output area of the cortical efferents helps with...
selection and switching among motor patterns? makes a copy of the intended plans and actions? focuses attention on relevant inputs? |
BG
cerebellum thalamus |
|
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which area projects strongly to the SMA and weakly to the PMA?
which area projects strongly to the PMA and weakly to the SMA? |
5 - internally guided (across body parts)
7- externally guided (extrapersonal space) |
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which areas are considered the "somatosensory cortex" ?
|
5-7
|
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where are bodies of the dorsal horn located?
|
III-VI
|
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where is the intermediate zone?
|
VII
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where is the substantia gelatinosa? what is processed here?
|
II, pain
|
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how many motor pools per mm?
|
1
|
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where is the motor pool for the phrenic n?
|
lamina IX of C4
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voluntary BB control in what nucleus?
|
onuf's nucleus
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anterior spinal nerve arises from _____a and supplies ______
|
vertebral a.
ventral white matter and most of the grey matter |
|
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posterior a supplies what
|
dorsal columns and dorsal horns
|
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ASIA A-
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complete
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ASIA B
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sensory preserved, motor lost
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ASIA C
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motor preserved with more than 1/2 key mm with <3
|
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ASIA D
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motor preserved, at least half key mm below injury = 3 or better
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ASIA E
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sensory and motor = normal
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low cervical injury =
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C7, C8, T1
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upper cervical injury =
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C5, C6
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HIGH cervical injury (ventilator dependent)
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C1,C2,C3,C4
|
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term for when stimulation of visceral afferents provoke excessive activation of the SNS
|
autonomic dysreflexia
|
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SCI may be unable to sweat where?
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below lesion
|
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durings CPGs, presynaptic inhibition occurs @ ______
|
synaptic terminals of 1a synapses themselves
|
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locomotion results from tonic stimulation of this site in the midbrain
|
mesencepahlic region
|
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can locomotor training help ameliorate allodynia in SCI patients?
|
yes
|
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is ACh inhibitory or excitatory in the BG?
|
inhibitory
|
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habituation occurs via ____
|
LTD
|
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2 mechanisms for changing synaptic strength
|
LTP and LTD
|
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when some corticospinal function is spared, the body can learn to adjust the size of stretch reflexes through_____ paradigm
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operant conditioning
|
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ballet dancers have small ______
|
H-reflexes
|
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what cells are depressed by alcohol and result in global ataxia?
|
purkinje cells
|
|
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what structure in the brain is assoc with short term memory?
|
hippocampus
|
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is conduction velocity normal or impaired in demyelinating diseases?
|
impaired
|
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if corticospinal origins are damaged, what other tracts can assist with functional recovery?
|
reticulospinal via PMRF projections and rubrospinal via red nucleus projections
|
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deifnition: when a nucleus loses a normal source of input and becomes more sensitive to other inputs
|
denervation hypersensitivity
|
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collateral sprouting occurs when a ______ neuron dies
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presynaptic
|
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|
regenerative sprouting occurs when a ____neuron dies
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post-synaptic
|
|
|
BG helps the ______
cerebellum helps the ______ |
cortex
entire motor system |
|
|
BG regulates the "___" of cortical output
Cb is the ____ of cortical output |
gain
comparator |
|
|
where is the pars compacta? what does it produce?
|
substantia nigra
dopamine |
|
|
is there any direct input to BG from the periphery?
|
no
|
|
|
main excitatory input to BG is from _____ and major output is to ______
|
cerebral cortex
modify pyramidal cells of the cortex |
|
|
striatum= ____+______
|
caudate + putamen
|
|
|
where is the substantia nigra located?
|
midbrain
|
|
|
BG primary input nucleus is the _____
BG primary output nucleus is the _____ |
striatum
GPi |
|
|
3 places the BG outputs go:
|
superior colliculus, layer 5 of the cortex, PPN (think reticular formation)
|
|
|
the pars reticulata is connected with the _______ to control ______
|
superior colliculus to control eye movement
|
|
|
only excitatory BG nucleus?
|
STN
|
|
|
what does the STN excite?
|
GPe
|
|
|
does dopamine presence help maintain normal oscillatory motion or abnormal synchronized motion?
|
normal oscillatory motion
|
|
|
GABA is inhibitory by______ the cell
|
hyperpolarizing the cell via (-) influx d/t opening Cl- channels
|
|
|
in HD, the inhibitory action of _____ is blocked
|
ACh
|
|
|
D1 =
D2 = |
excitatory
inhibitory |
|
|
net effect of the direct loop (D1)
|
facilitation
|
|
|
net effect of the indirect loop (D2)
|
inhibition
|
|
|
net effect of the direct loop + DA
|
facilitation
|
|
|
net effect of the indirect loop + DA
|
facilitation
|
|
|
which loop in indicated early in HD
|
indirect loop
|
|
|
direct loop releases (3)
|
GABA + substance P + dynorphin
|
|
|
indirect loop releases (2)
|
GABA + enkephalin
|
|
|
balance between ________ (indirect loop + DA) and ________ (indirect loop without DA) is necessary for BG function
|
thalamic disinhibition
subthalamic disinhibition |
|
|
vestibulocerebellum in is involved with the _____reflex
|
VOR
|
|
|
spinocerebellum is in the ___ and ____
|
vermis and paravermis
|
|
|
nucleus of vermis _______
to _____descending systems for ______ |
fastigial nucleus
medial for motor execution |
|
|
paravermis nucleus is ______
to _____systems for ____ |
interposed (globose and emboliform)
lateral ; motor execution |
|
|
cerebrocerebellum in _____
nucleus? to ___ and ____ for ____ |
lateral hemispheres
dentate nucleus motor and premotor for motor planning |
|
|
vestibulocerebellum is in the _______ to _____ nuclei for _____
|
flocculonodular to vestibular nuclei for balance and eye movements
|
|
|
which tract from Cb associated with efference copy
|
spinocerebellum
|
|
|
laterality of tracts in Cb?
|
mostly ipsilateral except the vestibulospinal has some B
|
|
|
Cb cortex processing modulates what?
|
output of DCN
|
|
|
each purkinje cell has one _______
|
climbing fiber
|
|
|
climbing fibers arise from the ______ and carry info about ____/_____
|
inferior olive
errors/timing |
|
|
what kind of fibers allow for coordination of elements of control?
ex: speed of ball and speed of raquet |
parallel fibers
|
|
|
output of climbing fibers?
|
complex spikes (contribute to LTD)
|
|
|
common cause of subarachnoid hemorrhage?
|
aneurysm
|
