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145 Cards in this Set
- Front
- Back
Anatomy and physiology
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-Functions to control various body activities.
-Structures of the nervous system include the central nervous system, peripheral nervous system, and autonomic nervous systems. |
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Cells of the nervous system
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-Nervous system is made up of two types of cells.
-Neurons: basic unit of the nervous system. -Neuroglial cells: function is to support neurons. |
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Neurons
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-Basic unit of the nervous system
-Do not regenerate, but axons can repair to some extent. -Rarely become primary brain tumors -Share three characteristics --Excitability: the ability to generate a nerve impulse --Conductivity – the ability to transmit an impulse --Influence – the ability to innervate target tissues |
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Excitability
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The ability to generate a nerve impulse
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Conductivity
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The ability to transmit an impulse
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Influence
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The ability to innervate target tissues
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Anatomy of a neuron
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Dendrites – receive impulses from surrounding neurons.
Cell body – impulses are transmitted to cell body. Axon – Impulse continues down axon and across synaptic cleft to adjacent neurons. Myelin sheath – a white lipid material produced by Schwann cells in the PNS and oligodendroglia in the CNS. Nodes of Ranvier – gaps in the myelin sheath that allow impulses to travel more quickly over the neuron. Neurotransmitters – chemical agents acetylcholine, norepinephrine, serotonin, dopamine, glutamate, and histamine. |
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Dendrites
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Receive impulses from surrounding neurons.
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Cell body
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impulses are transmitted to cell body.
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Axon
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Impulse continues down axon and across synaptic cleft to adjacent neurons.
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Myelin sheath
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A white lipid material produced by Schwann cells in the PNS and oligodendroglia in the CNS.
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Nodes of Ranvier
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Gaps in the myelin sheath that allow impulses to travel more quickly over the neuron.
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Neurotransmitters
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Chemical agents acetylcholine, norepinephrine, serotonin, dopamine, glutamate, and histamine.
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Neuroglial cells
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-Most numerous and function to support neurons.
-Have some ability to regenerate or repair themselves -Most primary brain tumors are neuroglial |
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Central Nervous System
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-Brain
-Spinal cord |
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Structures of the brain
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-Cerebrum
-Diencephalon -Brainstem -Cerebellum |
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Cerebrum
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-Controls high level functioning such as hearing, speech, personality, behavior, intellectual functioning, vision, memory, sensory and motor function
-Divided into two hemispheres -Left cerebral hemisphere controls language. -Right cerebral hemisphere controls perception. -90% of the population is left hemisphere dominant. |
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Four Lobes of the Cerebrum
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-Frontal
-Parietal -Occipital -Temporal |
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Frontal
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-Concerned with personality, behavior, emotions, and intellectual function.
**Broca’s area controls motor speech. |
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Parietal
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-Precentral gyrus center for sensation. Pain, temperature, touch, vibration.
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Occipital
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-Visual receptor center, interpreter shapes.
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Temporal
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-Auditory reception center.
**Wernicke’s area language comprehension |
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Diencephalon
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Contains:
-The basal ganglia -Thalamus -Hypothalamus -The limbic system |
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The basal ganglia
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Control voluntary and automatic movement such as arm swinging, swallowing and blinking.
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Thalamus
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Serves as a relay station for sensory information from the cerebellum to the cerebral cortex.
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Hypothalamus
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Regulates the ANS and endocrine system.
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Limbic system
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Controls appetite, sleep, emotional response, sexual response.
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Brain Stem
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-Contains the midbrain, pons, and the medulla.
-Contains the vital respiratory cardiovascular and vasomotor centers. -Contains the reticular formation – center for consciousness. -Controls sneezing, coughing, hiccupping, vomiting, sucking, and swallowing. |
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Reticular Formation
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**Center for consciousness
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Cerebellum
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-Located under the occipital lobe of the cerebrum
-Coordinates movement -Maintains trunk stability and gait -Operates on a subconscious level -Receives information from muscles, cerebral cortex, and inner ear. |
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Examination for Cerebellum Function
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-Observe posture and gait
-Finger to nose touch test -Pronating and supinating hands on thighs -Shallow knee bends -Opposition movements of thumb to each finger -Heel to shin test |
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Cerebral spinal fluid
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-Contained in the ventricles, subarachnoid space, and spinal canal.
-Ventricles of the brain are four fluid filled cavities that communicate with one another and with the spinal cord. -Averages 135 ml -Provides a cushion, nutrients, and allows shifts to occur during times of increased intracranial pressure. -Formed in the choroid plexus of the lateral ventricles and reabsorbed by the arachnoid villi in the subarachnoid space. |
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CSF analysis (Normal Values)
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Normal values:
-Specific gravity: 1.007 -pH: 7.35 -Appearance: clear, colorless -RBC: none -WBC: 0-8/ ul -Protein: 15-45 mg/dl -Glucose: 45-74 mg/dl -Microorganism: none -Opening pressure: 60-150 mm H2O |
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Lumbar puncture
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-Contraindicated in patients with elevated intracranial pressure and infection at the lumbar site.
-Place patient in the lateral recumbent position with the back near the edge of the bed. --Flex head to chest and knees up to the abdomen. -Puncture is made between L3 and L4 because there is a pocket of spinal fluid here. -Straighten patients legs before measuring pressures. -Post procedure maintain flat in bed for several hours to prevent spinal headache. -Observe for spinal fluid leaks. |
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Cerebral circulation
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-Blood supply to the brain is provided by the internal carotid arteries.
-Circle of Willis arises from the basilar artery and the internal carotid arteries. -This provides protection and collateral flow in case of arterial occlusion. |
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Blood Brain Barrier
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-Capillary membranes in the brain are less permeable to outside substances than capillaries in the rest of the body.
-This protects the brain from harmful chemicals and also affects medication absorption by brain tissue. |
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Meninges
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Three layers of protective membranes that surround the brain and the spinal cord:
-Dura mater (outer) -Arachnoid (center) -Pia mater (inner) Structures: -Falx cerebri: separates the cerebral hemispheres. -Tentorium: separates the cerebral hemispheres from the brainstem and cerebellum. |
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Dura mater
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Outer most layer
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Arachnoid
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-Center layer
-Arteries and veins reside here |
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Pia mater
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Inner layer
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Spinal Cord
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-Continuous with the brainstem
-Exits the cranial cavity at the foramen magnum -Grey matter arranged in an H shape surrounded by white matter |
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Grey matter of Spinal Cord
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Contains cell bodies of voluntary motor neurons, autonomic motor neurons, and cell bodies of association neurons
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White matter of Spinal Cord
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-Contains axons of the ascending sensory tracks and descending motor fibers.
-Myelin sheath gives the white matter its color |
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Pathways of the CNS
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-Spinocerebellar track
-Spinothalamic track -Posterior column (also known as....fasc... |
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Spinocerebellar track
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Major sensory track which transmits information about muscle tension and body position to the cerebellum for coordination of movement
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Spinothalamic track
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Carries pain and temperature sensation and crude touch
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Posterior column
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-also known as...
-carries sensation of vibration, position, light touch and manipulation of digits. |
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Stereogenosis
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– ability to identify a familiar object without looking
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Graphesthesia
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– ability to identify a letter drawn in your hand
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Sensory Receptors
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-Mechanoreceptors sense mechanical deformity
-Thermoreceptors sense temperature -Electromagnetic receptors detect light on the retina -Chemoreceptors detect taste, smell, oxygen levels, osmolality , and CO2 levels -Itch and tickle receptors |
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Sensory Testing
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Light touch – wisp of cotton
Pain and temperature – sharp and dull Vibration sense – tuning fork to bony prominences Position sense – move the finger up or down, Rhomberg test Two point discrimination Graphesthesia Stereognosis |
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Motor Tracks
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-Corticospinal tracks carry impulses from the cerebral cortex to cranial and peripheral nerves
-Upper motor neuron: cell bodies in the cerebral cortex. --Dysfunction causes weakness and paralysis, disuse atrophy, hyperreflexia, spasticity. -Lower motor neurons: Cranial nerves or spinal nerves which carry impulses to the end organ. --Dysfunction causes weakness and paralysis, atrophy, hyporeflexia, flaccid muscle tone. |
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Assessing Motor Function
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-Assess bulk tone, and strength of major muscle groups of the body.
-Passively move limbs through their normal range of motion. -Lack of tone = flaccid -Increased tone = spasticity |
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Peripheral nervous system
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-Spinal nerves
-Cranial nerves |
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Spinal Nerves
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-There are 31 pairs of spinal nerves
-They all exit the spinal cord at a given level and influence a specific body region. -There are: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. -They are labeled by number -Sensory dorsal root fibers each serve a specific part of the body, a dermatome. |
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Spinal nerves and dermatomes
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See pictures in lecture notes
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Cranial Nerves
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-12 pairs
-Emerge from the brain or brainstem -Have sensory and motor function |
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Cranial Nerve I
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Olfactory
-Olfactory nerve: sensory for smell. --Dysfunction can result from tumor in the olfactory bulb or basilar skull fracture. -History of sinusitis can effect the test -Testing: Have the patient identify a familiar smell such as coffee, chocolate with eyes closed. Test each nostril separately. |
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Cranial Nerve II
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Optic
-Sensory for sight: dysfunction may result from lesions to the optic nerve, optic chiasm or optic tract through the temporal, parietal or occipital lobe. -Testing: assess visual acuity with the Snellen chart visual fields -– The patient and examiner sit opposite each other at the same level. --The patient and examiner block one eye. An object is brought slowly into the visual field from each of four positions. The patient indicates when they can see the object. |
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Cranial Nerves III, IV, VI
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-III: Oculomotor
-IV: Trochlear -VI: Abducen nerve -Motor neurons which control movement of eye balls, elevation of eye lids, and pupillary constriction -Testing: assess eye muscle movement with 6 cardinal positions of gaze. --Ask the patient to move their eyes up and down --Check pupillary response to light direct and consensual. |
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Cranial Nerve V
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Trigeminal
-Motor for chewing -Palpate muscles of the jaw, ask client to resist attempts to open jaw -Sensory to cornea, mucosa of the mouth, nose, skin of the face and forehead. --Important in perceiving touch, temperature, pain -Only test corneal reflex in unconscious pt |
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Cranial Nerve VII
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Facial
-Motor to facial muscles -Sensory to taste on the anterior 2/3 of tongue -Inspect face for symmetry when patient looks up. Wrinkle forehead frown, puff out cheeks, raise eyebrows. Close eyes and squeeze them shut -Test taste on anterior 2/3 of tongue for sweet |
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Cranial Nerve VIII
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Acoustic
-Sensory for hearing in the cochlear division -Vestibular division controls balance -Cochlear division is tested with hearing test -Vestibular division is tested with ice caloric in unconscious patient, examiner irrigates the ear with ice water. Nystagmus and nausea normal. -Weber test: tuning fork to forehead -Rinne test: tuning fork to mastoid |
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Cranial Nerve IX
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Glossopharyngeal nerve
-Sensory for taste on the posterior 1/3 of the tongue -Motor innervates the pharynx, controls swallowing gagging and salivation -Test taste on the posterior portion of the tongue with sweet or salty. Test swallowing by having patient drink |
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Cranial nerve X
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Vagus nerve
-Sensory for external ear and pharynx. Motor to soft palate, larynx and esophagus. -Parasympathetic control to smooth muscle, cardiac muscle, and abdominal organs -Inspect the soft palate for symmetry, identify the uvula and record deviations from midline. Ask the client to say AH with tongue protruding observe uvula. Check for clear speech |
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Cranial Nerve XI
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Spinal accessory nerve
-Motor to the sternocleidomastoid and trapezius muscles -Evaluate for size symmetry and strength -Ask the client to turn their head to one side against your hand while you palpate the sternocleidomastoid. -Ask client to shrug shoulders against resistance |
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Cranial Nerve XII
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Hypoglossal
-Motor to the tongue for speech and swallowing -Ask the client to stick out their tongue. Inspect for size and symmetry -Push their tongue into their cheek against resistance |
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Reflexes
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-Biceps reflex
-Triceps reflex -Brachioradialis reflex -Patellar reflex -Ankle reflex |
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Superficial reflexes
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-Reflexes that can be elicited by stroking the skin or muscles .
-Abdominal, cremasteric, and plantar reflex |
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Abdominal reflex
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-Test spinal nerves at level T8 through t12.
-Stroke the skin of the abdomen with a blunt object up and away from the umbilicus and down and away from the umbilicus. -The umbilicus will move toward the stimulus. |
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Cremasteric and plantar reflex
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-Cremasteric: In males when the inner thigh is stroked the testicle on the same side moves.
-Plantar reflex: Stroking the plantar surface of the sole of the foot stimulates plantar flexion of the toes. -Bibinski reflex: In a positive Babinski test the toes of the foot go up and fan out to plantar stimulation. |
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Babinski's sign
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Dorsiflexion of the great toe and fanning of the other toes
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Elicitation of the plantar reflex
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-A hard object is applied to the lateral surface of the sole, starting at the heel and going over the ball of the foot, ending beneath the great toe.
-Normal response to plantar stimulation: flexion of all toes |