INTRODUCTION TO NEURO

DR.M.Shahid Shabbir
DPT,MSNMPT
THE NERVOUS SYSTEM
 What Two Organ Systems Control All the Other Organ
Systems?
 Nervous system characteristics
 Rapid response
 Brief duration

 Endocrine system characteristics

 Slower response
 Long duration
 What are the Two Anatomical Divisions?
 Central nervous system (CNS)
 Brain
 Spinal cord
 Peripheral nervous system (PNS)
 All the neural tissue outside CNS
 Afferent division (sensory input)
 Efferent division (motor output)
 Somatic nervous system
 Autonomic nervous system
FRONTAL LOBE
 The frontal lobe contains most of the dopamine-sensitive
neurons in the cerebral cortex.
 The dopamine system is associated with reward,
motivation, attention, memory, and planning.
 The ability to recognize future consequences resulting
from current actions, to choose between good and bad
actions.
 Higher mental functions.
The parietal lobe

 Integrates sensory information from different areas,

particularly determining spatial sense
 Visuo spatial processing.

The occipital lobe

 visual processing center 
THE TEMPORAL LOBE
 It is involved in auditory perception and is home to
the primary auditory cortex.

 It is also important for the processing of semantics in

both speech and vision.

 The temporal lobe contains the hippocampus and plays a

key role in the formation of long-term memory
NEURAL TISSUE ORGANIZATION
 What is the Anatomic Organization of CNS Neurons?
 White matter—Bundles of axons (tracts) that share origins,
destinations, and functions
NEURAL TISSUE ORGANIZATION
 What is the Anatomic Organization of PNS Neurons?
 Ganglia—Groupings of neuron cell bodies
 Nerve—Bundle of axons supported by connective tissue
 Spinal nerves
 To/from spinal cord

 Cranial nerves

 To/from brain
 What are the Pathways in the CNS?
 Ascending pathways
Carry information from sensory receptors to processing centers in the
brain
 Descending pathways
Carry commands from specialized CNS centers to skeletal muscles
THE CENTRAL NERVOUS SYSTEM
 Meninges—Layers that surround and protect the brain
and spinal cord (CNS)
 Dura mater (“tough mother”)
 Arachnoid (“spidery”)
 Pia mater (“delicate mother”)
THE CENTRAL NERVOUS SYSTEM
 What are the Brain Regions?
 Cerebrum
 Diencephalon
 Midbrain
 Pons
 Medulla oblongata
 Cerebellum
THE CENTRAL NERVOUS SYSTEM
 The Brain
THE CENTRAL NERVOUS SYSTEM
 Brain—The four hollow chambers in the center of the
brain filled with cerebrospinal fluid (CSF)
THE VENTRICLES OF THE BRAIN
THE CENTRAL NERVOUS SYSTEM
 The Formation and
Circulation of
Cerebrospinal Fluid
THE CENTRAL NERVOUS SYSTEM
 What are the Functions of the Cerebrum?
 Conscious thought
 Intellectual activity
 Memory
 Origin of complex patterns of movement
THE CENTRAL NERVOUS SYSTEM
 What are the Functions of the Cerebral Cortex?
 Primary motor cortex (precentral gyrus)
 Directs voluntary movement
 Primary sensory cortex (postcentral gyrus)
 Receives somatic sensation (touch, pain, pressure, temperature)
 Association areas
 Interpret sensation
 Coordinate movement
 THE CENTRAL NERVOUS SYSTEM
 Hemispheric Lateralization
 What is the Diencephalon?
 Switching
and relay center
 Components include:
 Epithalamus
 Thalamus

 Hypothalamus
 What are the Functions of the Thalamus?
 Relayand filter all ascending (sensory) information
 Coordinate voluntary and involuntary motor behavior
 What are the Functions of the Hypothalamus?
 Produce emotions and behavioral drives
 Coordinate nervous and endocrine systems
 Coordinate voluntary and autonomic functions
 Regulate body temperature
 What is the Anatomy and Function of the Brain Stem?
 Midbrain
 Process visual, auditory information
 Generate involuntary movements

 Pons
 Links to cerebellum
 Involved in control of movement

 Medulla oblongata
 Relay sensory information
 Regulate autonomic function
 What is the Anatomy and Function of the Cerebellum?
 Oversees postural muscles
 Stores patterns of movement
 Fine tunes most movements
 What are the Functions of the Medulla Oblongata?
 Relays ascending information to cerebral cortex
 Controls crucial organ systems by reflex
 Cardiovascular centers
 Respiratory rhythmicity centers
THE PERIPHERAL NERVOUS SYSTEM
 What are the Twelve Pairs Of Cranial Nerves?
 Olfactory (CN I)
 Sense of smell
 Optic (CN II)
 Sense of vision
 Oculomotor (CN III)
 Eye movement
 What are the Cranial Nerves? (continued)
 Trochlear (CN IV)
 Eye movement
 Trigeminal (CN V)
 Eye, jaws sensation/movement
 Abducens (CN VI)
 Eye movement
 Facial (CN VII)
 Face, scalp, tongue sensation/movement
 Vestibulocochlear (CN VIII)
 Hearing, balance
 What are the Cranial Nerves? (continued)
 Glossopharyngeal (CN IX)
 Taste, swallowing
 Vagus (CN X)
 Autonomic control of viscera
 Accessory (CN XI)
 Swallowing, pectoral girdle movement
 Hypoglossal (CN XII)
 Tongue movement
ASSOCIATION AREAS
a. Parieto-occipitotemporal association area

1. Analysis of the spatial coordinates of the body

2. Wernicke’s Area-important for language comprehension
3. Angular gyrus area-needed for reading
4. Area for naming objects
CONT…
b. Pre-frontal association area

1. Broca’s area-neural circuitary for word formation

c. Limbic association area-behavior, emotions, and

motivation

d. Area for recognition of faces

NEURONAL MECHANISM OF THE
FLEXOR REFLEX
NEURONAL MECHANISM OF THE
FLEXOR REFLEX
a. Involves the following basic types of circuits

1. diverging circuits to spread the reflex to the

necessary muscles for withdrawal

2. circuits to inhibit the antagonistic muscles

(reciprocal inhibition)

3. circuits to cause after discharge lasting after the

stimulus stops
BLOOD SUPPLY OF BRAIN & SPINAL CORD
ARCH OF AORTA
Right side------brachiocephalic artery------subclavian
artery-------common carotid artery

Left side------subclavian artery and common carotid artery

Common carotid artery Internal carotid artery

External carotid artery
INTERNAL CAROTID ARTERY
Carotid sinus
Arachnoids space

Branches
1-Ophthalmic artery
2-Choroidal artery
3-Posterior communicating artery
4-Anterior cerebral artery--smaller
5-Middle cerebral artery---larger
VERTEBRAL ARTERY
Branch of first part of subclavian artery

Branches

1-Meningeal branches
2-Posterior spinal artery

3-Anteior spinal artery

4-Posterior inferior cerebellar artery

5-Medullary arteries
ANTERIOR SPINAL ARTERY
Formed by two arteries

Anterior 2/3rd of spinal cord

Posterior spinal artery

Posterior 1/3 rd of spinal cord

MIDDLE CEREBRAL ARTERY (PINK); LATERAL SURFACE
POSTERIOR CEREBRAL ARTERY (GREEN); AND
ANTERIOR CEREBRAL ARTERY (BLUE).
BASILAR ARTERY
Union of two vertebral arteries
Anterior surface of pons

Divides into two posterior cerebral artery

Branches

1-Pontine artery
2-Labyrinthine artery

3-Anterior inferior cerebellar artery

4-Superior cerebellar artery

5-Posterior cerebral artery

CEREBRAL BLOOD FLOW
Unconsciousness occurs in 5-10 seconds if the blood
supply of brain completely cut off.

Neuronal function ceases after 1 minutes

Irreversible changes start to occurs after 4 minutes

Can be delayed if the patient’s body has been cooled

THE PERIPHERAL NERVOUS SYSTEM
 Peripheral Nerves
and Nerve Plexuses
 Reflex—An automatic involuntary motor response to a
specific stimulus
 Dorsal Sensation
Arrival of Activation of a root relayed to
stimulus and sensory neuron the brain by
activation of collateral
receptor

REFLEX
ARC
Stimulus Receptor

Ventral
root
Information
processing
in CNS
Activation of a Activation of a
motor neuron motor neuron

Sensory neuron
(stimulated)
Excitatory
interneuron
Motor neuron
(stimulated)
•The Posterior Column
Pathway
•The Corticospinal
Pathway
THE AUTONOMIC NERVOUS SYSTEM
 What Is The Autonomic Nervous System?
 Branch of nervous system that coordinates
cardiovascular, digestive, excretory, and reproductive
functions
 What are the Two Divisions of the ANS?
 Sympathetic division
 “Fight or flight” system
 Parasympathetic division
 “Rest and digest” system
THE SYMPATHETIC DIVISION
 What are the Effects of Sympathetic Activation?
 Generalized response in crises
 Increased alertness
 Feeling of euphoria and energy
 Increased cardiovascular activity
 Increased respiratory activity
 Increased muscle tone
THE PARASYMPATHETIC DIVISION
 What are the Effects of Parasympathetic Activation?
 Relaxation
 Food processing
 Energy absorption
 Brief effects at specific sites
Clinical Decision Making
 Clinical reasoning
 Clinical Reasoning is the process by which a therapist

interacts with a patient, collecting information,

generating and testing hypotheses, and determining
optimal diagnosis and treatment based on the
information obtained

 Information
 Decisions

 Actions

 Forward reasoning process

 Backward reasoning process (hypothetic-deductive

process)
 Models of Disablement

 Disease, sign, symptoms

 Impairments (direct & indirect)

 Functional limitation

 Disability
 Quality of life
APTA MODEL OF PRACTICE
1. Examination
 History
 Systemic Review
 Tests and Measurements
2. Evaluation
3. Diagnosis
4. Prognosis
5. Intervention
6. Reexamine
THREE COMPONENTS OF PHYSICAL
THERAPY INTERVENTION
 Coordination
 Communication

 Documentation

 Patient / client related instruction

 Procedural intervention
MODEL OF DISABLEMENT
WHO Model
 Disease – Impairment – Disability - Handicap
Nagi Model
 Active Pathology – Impairment – Functional
Limitation - Disability
NCMRR Model
 Patho -physiology – Impairment – functional
Limitation – Disability – Societal Limitations
 ICF Model

 Disease/no disease, impairment/no impairment,

activity/activity limitations, participation restriction.
Intervention:

 Restorative
 Compensatory

 Preventative

 FITT (frequency, intensity, time and type)

 EBP
DOCUMENTATION

 POMR (problem oriented medical record)

 4 phases

1. Formation of database
2. Identification of problem
3. Identification of special treatment
4. Assessment of effective treatment

 SOAP
Clinical decision making

 Expert vs Novice

 Knowledge base and experience

 Cognitive processing style (receptive data gathering vs

procedural)

 Self monitoring strategies

 Communication and teaching skills