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Ascending Tracts

Carry sensory impulses to the brain from receptors of skin, muscle and organs

Lateral Spinothalamic Tract

Pain and Temperature

Posterior Dorsal Column

Touch and Propreoception

Innervation of Spinothalamic Tract

DRG to cross central part of gray and white matter to opposite side of Spinal Cord white matter up tract to Thalamus and to the Primary Sensory Cortex

Location of Sensory Cortex

Posterior central gyrus of parietal lobe

Innervation of Posterior Dorsal Column

DRG and straight up to medulla to the Primary Sensory Cortex

Spinothalamic Tract (contralateral or ipsilateral?)

contralateral

Posterior Dorsal Column (contralateral or ipsilateral??)

ipsilateral; contralateral in cerebral hemispheres.

Test pain and temperature

Sharp and Dull with cotton tip for pain; hold tube with hot water for temperature.

Lesion on Spinothalamic Tract

Contralateral loss of pain and temperature below level of lesion

Lesion on Dorsal Column Tract

Ipsilateral loss of touch and proprioception below level of lesion

If entire cord damaged, what happens below lesion?

No sensation below lesion; full sensation above the lesion

If only half the cord damaged, what happens below lesion?

Contralateral loss of pain and temperature below the lesion; Ipsilateral depends on which side...

Anterior Horn Cells

Lower Motor Neurons that innervate cervical spine and skeletal muscle

Lateral Corticospinal Tract

Upper Motor Neurons related primarily to the Brain and Spinal Cord.

UMN lesion

spastic paralysis

Motor Cortex location

precentral gyrus of the frontal lobe in each cerebral hemisphere.

LMN lesion

Flaccid paralysis

Etiology of UMN paralysis

Stroke

Etiology of LMN paralysis

Trauma- gunshot or stab wound

Reflex Arc

involuntary response to stimulus mediated by the spinal cord; not voluntary

Sensory Reflex Pathway

DRG- synapse in SP with motor neurons in anterior root- synapse in SP and back to the same muscle.

Biceps SC location

C5 and C6

Triceps SC location

C6 and C7 and C8

Brachiorradialis SC location

C5 and C6

Patellar SC location

L2 and L3 and L4

Achilles SC location

S1 and S2

Normal Reflex Results

Skeletal muscle contracts when they are stretched by the pull of gravity or external manipulation or when their tendons are stretched.

Clonus

Set of rhythmic contractions of the same muscle

Hyperactive Reflex

exaggerated reflex seen when monosynaptic reflex arc released

Hyporeflexia sign of

LMN injury-destruction of anterior horn cell

Hyperreflexia sign of

UMN injury- Stroke

Stereognosis

Pt feels an object and identifies it

Graphesthesia

Pt feels letters or numbers written on their skin and identifies it

Alert

Pt. is awake and oriented

Lethargic

Pt appears drowsy and may fall asleep if not stimulated

Obtunded

Pt is difficult to arouse from sleep like state; Sleeps most of time; confused when awake

Stupor

Pt responds only to strong generally painful stimulus; returns to unconscious state when it stops.

Coma

Completely unconscious pt - cannot be aroused even by strong painful stimulus

Glasgow Coma Scale

Used for head trauma- Score 3-15, based on Eye opening, Verbal response and Motor response.

Mild Head Trauma

Glasgow Score 14-15; 3% may deteriorate within 48 hours

Moderate Head Trauma

Glasgow Score 9-13; 20% chance of death; 50% chance of long term disability

Severe Head Trauma

Score Less than 9; 40% chance of death in 48 hours

Decorticate posturing

Hands contracted in; Lesion of cerebral cortex

Decerebrate posturing

Hands contracted out; Lesion in brain stem

Brocas aphasia

Can comprehend language, but cannot use motor/speech to get the words out; may have paralysis of upper limb on the right

Wernike's aphasia

unable to comprehend language; speech is used but with wrong words

Charcots Triad

Widening pulse pressure, bradycardia and irregular breathing patterns

Layers of Skin

Epidermis, Dermis and Subcutaneous

Functions of Skin

Protection, Sensory, Temperature, Wound repair, Absorption and Excretion, Production of Vitamin D

Preparation for Skin Assessment

Warm room, good lighting, modesty, use proper equipment, Inspect and Palpate

Inspection of Skin

Look for discoloration, masses, lesions, rashes, bruising (ecchymosis)

Palpation of Skin

Palpate for Edema, Turgor (elasticity), Moisture, Temperature and Texture

Purpuric

Caused by blood flowing out of breaks in vessels

Petechiae

tiny puntate hemorrhages- 1-3 mm round; dark red, purple or brown

Purpura

Confluent and extensive patch of petechiae and ecchymosis >3 mm flat, red to purple

Causes of Purpuric

Thrombocytopenia and scurvy

ABCDEs

Test for Melanoma- Asymmetry, Border Irregularity, Color Variation, Diameter greater than 6 mm, Elevation/Enlargement

Skin Cancer Risk Factors

History, Change in pigmentation or mole, excessive dry or moist, pruritus, bruising, rash or lesion, medications, hair loss

Aphasia

impairment of language modality; Brocas and Wernickes

Brain lesion on the right

contralateral left sided spastic paralysis

Spinal lesion on the right

ipsilateral right sided spastic paralysis

Initial lesion of UMN

spinal shock, pronator weakness followed by spastic paralysis

Spinal cord completed transected

Spastic paralysis below the level of the lesion- on both sides

Anterior Horn cell lesion on right side

Flaccid paralysis on the right side-ipsilaterally- AT THE LEVEL OF THE LESION ONLY

Spinal cord transected also damages Anterior Horn

Spastic paralysis below level of Spinal cord lesion and flaccid paralyis at the level of the anterior horn damaged.

Stroke can damage both

motor and sensory

Dorsal Column Disease

Syphilis

Anterior Horn cell disease

Polio

Thumb SC location

C6

Digits 2&3 SC location

C7

Digits 4&5 SC location

C8

Nipple SC location

T4 & T5

Umbilicus SC location

T10

Big Toe SC Location

L4

Middle Toes SC Location

L5

Little Toe SC Location

S1

Dermatome

cutaneous area supplied by the spinal nerve

If patient seems arythmic

use reinforcement technique

Reinforcement Technique

Ask the pt. to perform an isometric exercise in a muscle group away from the one being tested.

Plantar Reflex SC location

L4 to S2

Babinski Reflex sign of

UMN lesion

Paralysis of upper limb on right

sign of Brocas aphasia

Dementia

progressive deterioration of intellect, behavior and personality due to loss of cortical neurons.

If Brain is deprived of oxygen for 3-5 minutes

Irreversible Brain Damage occurs

Tract

bundle of fibers which has the same origin and destination and carries similar impulses.

Kinesthesia- Position Sense

Hold finger and move up, down, left and right; have patient tell which way you are moving it

Position Sense tests the

Posterior Dorsal Column Tract

Romberg Test tests the

Posterior Dorsal Column Tract

Positive Romberg with eyes open and closed

Cerebellar deficit ataxia

Positive Romberg with eyes closed only

Proprioceptive deficit- Sensory ataxia

Two point discrimination

the ability to discriminate whether one or two areas of skin are being stimulated

Fingertips

2-8 mm

Back

40-75 mm

Dysmetria

Clumsy movements

Ataxia

uncoordinated unsteady gait

Cerebellum

Coordination Equillibrium and Balance

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