Injury Without Pain Congenital Analgesia People who are born without the ability to feel pain often sustain extensive burns, bruises, and lacerations during childhood. Usually these people show severe pathological changes in the weight-bearing joints, especially of the hips, knees, and spine, which are attributed to the lack of protection to joints usually given by the sensation of pain.
The condition of a joint that degenerates because of failure to feel pain is called the 'Charcot' or neurotrophic joint. It has long been known that if the nerves that normally innervate a joint are missing or defective, a condition in which the joint surfaces become damaged and the ligaments and other tissues become stretched and unstable develops.
I-listological and physical examination of the nerves and nerve activities surrounding this loss of pain show no abnormal nerve activity or abnormal concentrations of cerebrospinal endorphins. Episodic Analgesia Cases of congenital analgesia are rare. Much more common is the condition most have experienced at one time or another, that of sustaining an injury, but not feeling pain until many minutes or hours afterwards.
Injuries may range from minor cuts and bruises to severe broken bones and even the loss of a limb. Soldiers in the heat of battle frequently described situations in which an injury has not produced pain.
In studies performed on these injured soldiers, it was found thaL they were not in a state of shock nor were they totally unable to feel any pain, for they complained as vigorously as a normal man at an inept nurse performing vein punctures.
It may occur with small skin ClIIS on an ann or leg or with the arm or leg blown ofrby explosives. It has no simple relationship to the circumstances. I t may occur i n the heat of battle, or when a carpenter CUtS off the tip 0 hi5 fi nger, trying to make a n accurate cut. The victim does not first feel pain and then bring i t under control. The analgesia has a l i m i ted time course, usually by the next day all these people are 6.
People may complain about olher more minor injuries at other locations on the body. Pain Without Injury In contrast to people who fail 1O feel pain at the time o f injury are people that develop seen in practi ce include tension headaches, m igraines, fibromyalgia, trigem inal neuralgia, and back pain without apparelll injury. Examples of conditions commonly pain. In central pain, an arm or a leg that apparently has nothing wrong with it can hurt so much or feel so strange that patients struggle to describe the pain or the feel i ngs that they perceive Boivie The characteristics of central pain include steady burning, cold, pins and needles, and lacerating or aching pain although no one charilcteristic is pathognomonic Bowsher 1 9 Central pain can be associated with breakthrough pain and decreased discriminative sensation.
Onset can be delayed, particularly after stroke. There are considerable differences in Ihe prevalence of central pain among the various disorders associated with it. The highest i ncidence of central pain occurs in mulliple sclerosis MS , stroke, syringomyelia, tumour, epilepsy, brain or spinal cord Irauma, and Parkinson's disease Boivie 1 ; Siddall el a1 ; Osterberg et al Treatment of central pain syndrome is difficuh and often frustrating for both the Anti.
Pain medications are generally only partially effective. The funclional neurological approach has been as effective as any therapies at decreasing the symptoms of central pain.
The following questions are helpful as a guide to approaching the treatment necessary patient and the praclitioner. I, At what level of the neuraxis has the damage occurred? Is the damage reversible? A t what level of t h e neuraxis h a s central sensitization o r reorganization occurred? What options are available to influence these processcs? The Spinal Cord and Peripheral Nerves I Chapter 7 Pain Disproportionate to the Severity of Injury C kidney may, under certain conditions, concentrate some components in the urine so that these compounds precipitate out oCthe urine and form small kidney Slones or renal caletlli.
Small pieces of the stones break off and pass inw the ureter that leads from the kidney 10 the bladder. In size, they are not morc than twice the size or the normal diameter of the normal ureter.
Pressure builds up behind the plug formed by the stone, tending to drive it into the ureler and as a resuil, the muscle i n the wall of the ureter goes il1lO localized strong contraction. TIl is band of contraction moves down the ureter to produce peristaltic waves to drive the stone down.
During this process called 'passing a slone' agonizing spasms of pain sweep over the patient in such a way that even the toughest and most stoical of d,aracters usually collapse. Even crying out because of the pain is restrained because all movement exaggerates the pain. As the stone passes into the bladder there is i m mediate and complete relief of the pain resulting in an exhausted patient. Funhermore, it OCGlrs in a structure which is poorly innervated when compared to other areas of the body.
Several terms are used to describe pain disproportionate to the inj ury or not appropriate to the stimulus causing the pain. I lyperalgesia can be classified as either primary or secondary in nature. Primary hyperalgesia resu lts from the release of various chemicals at the site of injury, leading to sensitization of nociceptive afferents.
Secondary hyperalgesia involves collateral branches of the nociceptive afferents at the level of the spinal cord, which resuhs in the regions surrounding the site of injury becoming more sensitive to pain. Allod l1Iia is the teml used to describe pain produced by normally i n n ocuous stimulation.
For example stroking the skin would not normally be pai nful; however, st. With allodynia there is no pain i f there i s no stimulus, unlike other lypes of pain that c. Schaible I IC. Von Hanchet CS Mechanisms of pain in arthritis. Personal communication.
An experimental Siddall study with the Nauta method. Experimenlai llrain Research A longitudinal study of the prevalence and charaneristics 7: 1 2 0 - 1 Pain Osterberg A.
McClelland 1M. Rutkowski SB et al , multiple sclerosis-prevalences. Journal of Neurophysiology 1 1 Rainville P. Duncan CII. Science 1. I lebb ledure. Brain 1 2 1 : 1 nexed n 1 Some aspects of the cytoarchitectonics and synaptology of the spinal cord. Progress in Brnin nesearch 1 1 ,, Romanelli I , Esposito V llle functional anatomy of neuropathic pain. Neurosurgery Clinics of North America and modulation in the dngulated gyrus.
Kalso L. Coggeshall Rl Sensory mechanisms of the spinal cord. New York. In: Paxinos C, Mili 1 Rowbotham MC. Kidd HI.. Porreca r Role of cemral sensitization in chronic pain: osteoarthritis and rheumatoid arthritis compared to neuropathic pain.
In: rlor I I. IK eds The human nervous system. Wenk l i N, I ionda eN et a1 Locations of spinothalamic lract axons in cervical and thoracic spill In the JOints relay information to the spinal cord concerning movement and proprioception The ventra' spinocerebellar pathway onvey.
Soft tissue swelling around the injUry resulting in spinal compression; Bone displacement due to the fracture, resulting in cord compression; 4 Brachial plexus injury not diagnosed; and 5, Intracranial haemorrhage. Sympathetic system; 2. Parasympathetic system; and 3. Enteric system. The sympathetic nervous system can function more generally with respect to its less precise influence on physiolo! Both the sympathetic and parasympathetic systems are LOnically active to help maintain a stable imernal environment in the face of changing external conditions which is best described as homeostasis.
Both the sympathetic and parasympathetic systems comprise preganglionic and postganglionic neurons. The cell bodies of preganglionic neurons in the sympathetic system are located in the intermediolateral cell column IML of the spinal cord between Tl and L2.
The axons of these neurons exit the spinal cord via the ventral root with the motor neurons of me ventral horn. A branch known as the white rami communicans myelinated carries these fibres to the sympathetic chain ganglia where many of the preganglionic cells synapse with postganglionic cells.
At cervical and lumbar levels, Copyrighted Material Functional Neurology for Practitioners of Manual Therapy postganglionic sympathetic neurons form grey rami communicans unmyelinated and slower conducting that are distributed to vascular smooth muscle.
At cervical levels, some of lhe postganglionic neurons also project to the eye, blood vessels, and glands of the head and face via the carotid and vertebral arterial plexi. The cell bodies of parasympathetic preganglionic neurons are located in discrete nuclei at various levels of the brainstem and at the IML column of levels in the spinal cord vertebral level LI In contrast to the sympathetic system, the preganglionic parasympathetic neurons are generally longer than the postganglionic neurons as they synapse in ganglia funher from their origin and closer to the effector than the postganglionic neurons innervate.
Organization of the Autonomic Nervous system nle autonomic nervous system comprises the major autonomous or non-volitional efferent outflow to all organs and tissues of the body with the exception of skeletal muscle.
The preganglionic component neurons live in the grey matter of the spinal cord. The postganglionic component neurons vary in location with some living in the paraspinal or sympathetic ganglia. Although historically only the efferent connections were considered. The autonomic system can be divided into three functionally and histologically distinct components: the parasympathetic. All three systems are modulated by projections from the hypothalamus.
Hypothalamic projections that originate mainly from the paraventricular and dorsal medial nuclei influence the parasympathetic and sympathetic divisions as well as the enteric division of the autonomic nervous system. They finally terminate on the neurons of the parasympathetic preganglionic nuclei of the brainstem.
Descending autonomic modulatory pathways also arise from the nucleus solitarius, noradrenergic nuclei of the locus ceruleus, raphe nudei. Axons of the preganglionic nerves of the parasympathetic system tend to be long, myelinated. The cell bodies of parasympathetic preganglionic neurons are located in discrete nuclei at various levels of the brainstem as described above and in the intennediolateral cell column of levels in the spinal cord or vertebral level LI In contrast to the sympathetic system.
The neurotransmitter released both pre- and postsynaptically is acetylcholine. Cholinergic transmission can occur through C-protein coupled mechanisms via muscarinic receptors or through inotropic nicotinic receptors. The activity of ACh is terminated by the enzyme acetylcholinesterase.
To dale. Cholinergic, muscarinic receptors are present on the end organs of postsynaptic parasympathetic neurons Fig. Kidney Preganglionic fibres - Fig 8 1 This figure outlines the parasympathetic outflow to the body Including the cranial nerves III, VII, and IX, the vagus nerve CNX and the pelvic dIViSion of spinal nerves The neurological Olltput from the parasympathetic system is the inlegrated end product of a complex interactive network of neurons spread throughout the mesencephalon.
POllS, and medulla. The outputs of the cranial nerve nuclei including the Edinger-Westphal nucleus, the nucleus tractliS solilarius, the dorsal motor nucleus, and nucleus ambiguus are modulated via the mesencephalic reticular fonnation MRF and PMRF.
Brodal ; Brodal ; Brown ; Webster The relationship of the parasympathetic outflow to the immune system has received very little study to date and as a consequence very little is known about the influence of the parasympathetic or the enLeric system on immune function. Supraspinal Modulation of Autonomic Output Monosynaptic connections between two structures suggest an important functional relationship between the two structures in question.
Monosynaptic connections have been demonstfiued to exist between a variety of nudei in the medulla, pons, diencephalon. The hypothalamus is the only stmcture with direct monosynaptic connects to the nuclei of the brainstem and to the neurons of the IML. The projections from the cerebral cortex and their role in modulation of autonomic function are not well understood.
Neurophysiological studies demonstrating autonomic changes with stimulation and inhibition of the areas of cortex also suggest a regulatory role. The following outlines the established areas of cortex and their projection areas: 1.
Medial prefrontal cortex has direct projections to the amygdala, hypothalamus, brainstem, and spinal cord areas involved in autonomic control. The insular and temporal pole areas of cortex also demonstrate direct projections to the amygdala, hypothalamus, brainstem, and spinal cord areas involved in autonomic control. Primary sensory and motor cortex are thought not to control aUlonomic activity directly but to coordinate autonomic outflow with higher mental functions, emotional overlay, and holistic homeostatic necessities of the system.
Acrurately assessing the asymmetric functional output of the autonomic nervous system is a valuable clinical tool in evaluating asymmetrical activity levels of conical or supraspinal structures that project to the output neurons of the autonomic system. The Autonomic Ganglion 'Ine autonomic ganglion is the site al which the presynaptic neurons synapse on the postsynaptic neurons.
Incoming and outgoing nerve bundles are attached to the ganglion Fig. The outgoing bundle contains postganglionic axons, and afferent fibres from the periphel ' entering the ganglion Snell The presence of such a complex structure in the ganglion has lead to the suspicion that the ganglion are not just relay points but integration stations along the pathway of the autonomic projections.
These fibres are the axon projections of neurons located in the Edinger-Westphal EWN or accessory oculomotor nuclei. The parasympathetic projections travel with the ipsilateral oculomotor nerve and exit with the nerve branch to the inferior oblique muscle and enter the ciliaI ' ganglion where they synapse with the postganglionic neurons. The axons of the postganglionic neurons then exit the ganglion via the shon ciliary nerves and supply the ciliary muscle Copyrighted Material Functional Neurology for Praditioners of Manual Therapy and the sphincter pupillae.
Activation orthe postganglionic neurons causes contraction of bOlh the ciliaI ' muscle. These actions can be slil11ui. The left LWN stimulation results in constriction of the ipsilateral left pupil. Some fibres from the left optic tract also synapse on the right I'WN, effeclively resulting in constriction of both pupils. This in addition to funher evaluation of the oculomotor and trochlear function can then be used to estim.
In situations where the CIS of one FWN is undergoing transllcural degeneration of relatively shon duration, one would exped. On prolonged stimulus a pupil in this condition will often fluctuate the pupil size between normal and pania!
The thalamus and hypothalamus have traditionally been thought of as a simple relay system and the master control over the pituitary gland respectively. But as our understanding of the functions of these areas of the neuraxis grows so does the variety of functions these areas cOl1lribute 10 human function.
The thalamus is now thought to play a vital role in the innate stimulatory patterns of wide areas of conex that allow consciousness. In this chapter we will explore the anatomy and neurological functional circuits of these interesting and clinically relevant areas of the neuraxis. Copyrighted Material Functional Neurology for Practitioners of Manual Therapy Anatomy of the Thalamus The diencephalon encloses the third ventricle and includes the thalamus with its lateral and medial geniallale bodies, the subthalamus, the epithalamus, and the hypothalamus.
Each cerebral hemisphere contains a thalamus, whidl is a large egg-shaped mass of grey malter, in the dorsal ponion of the diencephalon Fig. The thalamus is an important link between sensory receptors and cerebral COrtex for all modalities except olfaction. T"ese projea. The superior peduncle carries projeoioll fibres to and from the ventral and lateral thalamic nuclei to the pre- and postcentral gyri and premotor and prese:nsory areas of the cortex.
I A cross-sectional view of the anatomical relationships Copyrighted Material of the diencephalon. The thalamus has seven groups of nucle. Several nuclei of the thalamus are considered to be areas of singularity dependent on neuml activation from the COrtex to survive.
This process is an example of diaschisis, where reduced output of the neuraxis results in degeneration of the downstream neuron pools.
Neurons in the anterior thalamic group project to regions of the cingulate and frontal cortices, mainly areas The medial nuclei are composed of a number of small nuclei including the parafascicular, submedius, paracentral is, and paralateralis. The medial nuclei form reciprocal projections from the hypothalamus.
These nuclei also form reciprocal projections with all other thalamic nuclei. Dysfunction of the medial nuclei in man results in complex changes in motivational drive, in problem-solving ability, and in emotional stability.
The ventral nuclear group is composed of three nuclei, the ventral anterior VA , the ventral posterior VP , and the ventral intermedius VI. The ventral posterior nucleus is further divided into the functionally important ventral posterior lateral VPL and ventral posterior medial VPM nuclei.
These nuclei project reciprocally via the posterior limb of the internal capsule to the somatosensory areas including areas I, 2. The VI projects to other thalamic nuclei and 10 the motor areas of cortex namely areas 4 and 6. The VA nucleus receives extensive projections from the globus pallidus via the thalamic fasciculus and from the dentate nucleus of the cerebellum.
All afferent and efferent projection fibres, to and from the thalamus, pass through this reticular nuclear area. The neurons of this nucleus are predominantly CABA-ergic in nature, while other thalamic nuclei are mainly excitatory and glutaminergic. These nuclei receive a predominance of their projections from the reticular formation of the brainstem and project to the corpus striatum and cerebellum.
The functional significance of these nuclei remains a mystery. The nucleus consists of six layers of nerve cells and is the temlinus of about Al of the fibres of the optic tract. The remaining projeaions arise from the brainstem reLicular formation, the pulvinar, and reciprocal projections from the striate cortex.
The medial geniculaIe nucleus MeN or body is the tonotopically organized auditory input to the superior temporal gyrus. It appears as a swelling on the posterior surface of the pulvinar. Afferent fibres arriving in the medial geniculate body from the inferior colliculus form the inferior brachium. TIle MeN receives audito! Image from the upper visual field is projected onto the lower retina and that from the lower visual field OntO the upper retina. The left visual field is projeaed to the right hemiretina of each eye in such a fashion that the right nasal hemiretina of the left eye and the temporal hemiretina of the right eye receive the image.
The fovea receives the corresponding image of me centr. The macula comprises the space surrounding the fovea and aJso has a relatively high visual aruity. This area although functionally important has no photoreceplors. When both eyes are functioning, open, and forused on a central fixation point. This means that Lhese areas only receive information from one eye. If that eye is dosed, the area representing the blind spot of the eye remaining open will not be activated because of the lack of receptor activation at the retina.
It is expected that when one eye is closed the visual field should now have an area not represented by visual input and the absence of vision over the area of the blind spot should be apparent. However, this does not occur. The cortical neurons responsible for the area of the blind spot must receive stimulus from other neurons thai creale the illusion that the blind spot is not there.
Perceptual completion refers to the process whereby the brain fills in the region of the visual field that corresponds to a lack of visual receplOrs.
This explains why one generally is not aware of the blind SpOt in everyday experience. The integrative state of the horizontal neurons is detennined lO some extem by the activity levels of the neurons in the striate conex in general.
Several faaors can contribute to the CIS of striate conical neurons; however, a major source of stimulus results from thalamoconical activation via t.
It is dear from the above that the majority of the projection fibres reaching the LeN are not from retinal cells. In , Professor Frederick Carrick discovered that asymmetrically altering the afferent input to the thalamus resulted in an asymmetrical effect on the size of the blind spot in each eye. The blind spot was found to decrease on the side of increased afferent stimulus.
This was attributed to an increase in brain function on the contralateral side because of changes in thalamocortical activation that occurred because of multi modal sensory integration in the thalamus. By decreasing the threshold for firing of neurons in the visual conex, the manipulation resulted in a smaller blind spot because the area surrounding the permanent geometric blind spot zone is more likely lO reach threshold and respond to the receptor activation that occurs immediately adjacent to the optic disc on the contralateral side.
Professor Carrick proposed that 'A change in the frequency of firing of one receplOr-based neural system should effect the central integration of neurons that sh..
Care should be taken nOt to base tOO much clinical significance on the blind spot sizes until any pathological or other underlying cause that may have resulted in the changes in blind spot size are ruled out. An ophthalmoscopical examination is therefore an important component of the functional neurological examination. There are several Olher valuable ophthalmoscopic findings discussed in Chapter 4 that can assist with estimating the CIS of variOliS neuronal pools.
Functions of the Thalamus 'Ine thalamus receives input from every afferent sensory modality with the exception of olfaction. Olfactory perception occurs in the primary and secondary olfactory areas of the cortex, thus bypassing the thalamus. Spontaneolls, contralateral, pain that is often excessive in nature to the stimulus may follow thalamic lesions such as infarction. This type of pain is referred to as ellalamic pain..
Movement disorders involving choreoathelOid movements may result following thalamic lesions. Processing of Thalamic Input Sensory input from all modalities except olfaction do not reach the cerebral cortex directly but first synapse on thalamocortical relay neurons in specific regions of the thalamus. These relay neurons in turn project to their respective are In addition to relaying sensory input the thalamic relay neurons also have intrinsic properties that allow them to generate endogenous threshold activity and exhibit complex firing patterns Sherman Following a period of inhibition stimulus, in certain circumstances they can produce bursts of low-threshold spike action potentials referred to as post-inhibitory rebound bursts.
In addition to displaying integrate and fire and bUTSt and tonic modes of behaviour. Curro Dossi et al The thalamic reticular neurons also produce oscillatory activity but in the range Hz Contreras In fact it appears that cortical feedback is necessary to maintain the thalamic oscillations.
One theory suggests that the thalamic oscillations are utilized by a variety of structures in the brain to promote neuroplaslic change through the constant repetition of synaptic stimulation that would result frolll the periods of oscillations in a neural circuit. The hippocampus recalls events that have happened throughout the day and presents them to the cortex. It is clear from the above discussions that the thalamic integration of multimodal projections and the complex firing palterns seen in thalamic neurons position the thalamus as a key integrator and runctional element in the neuraxis and not a simple relay centre as once thought.
Anatomy of the Hypothalamus The hypothalamus lies below or ventral to the thalamus and rorms the floor and lateral inferior walls of the third ventricle. The hypothalamus is composed of a number of strudures induding the mammillary bodies, the tuber cinereulll. The nuclear groups of the hypothalamus are divided by the fornix and the mammillothalamic tract into medial and lateral zones.
The medial zone contains eight distinct groups of nuclei induding the preoptic nucleus, the anterior nucleus, a section of the suprachiasmatic nucleus. Afferent Inputs to the Hypothalamus Afferent projections to the hypOlhaJamus can take two basic forms. Direct projeaions, which fonn fairly distinct anatomical pathways.
Copyrighted Material Functional Neurology for Practitioners of Manual Therapy The Hypothalamus Receives a Number of Prominent Projections from Limbic System Structures 'l'lle hypothalamic nuclei receive: projections from a variety of areas of the neuraxis known to contribute to functional aspeclS of the limbic system.
Thefom ix is a fibre bundle that projects from the hippocampal formation to the mammillary bodies. The fornix receives collateral contributions from the cingulate gyrus and many of the septal nuclei as it curves venlIally towards the anterior commissural area.
The fornix divides into two columns or crura at the anterior commissural area Fig. Before the anterior commissure intersects with the crural fibres the fornix gives rise to precommissural projections to the preoptic regions of the hypothalamus. The postcommissural fornix gives rise to projections to the dorsal, lateral, and periventricular regions of the hypothalamus before terminating in the mammillary bodies of the hypothalamus.
The amygdaloid complex projects to the preoptic regions and to a variety of other hypothalamic nuclei via the amygdalohypothalamic fibres that arise from two different pathways, the stria terminalis and the ventral amygdalofugal tract The medial forebrain bundle Fig.
Fibres from the seplal nuclei, the olfactory cortex, and orbitofrontal conex descend in this tract to the hypothalamic nuclei. Fibres from the pontomedullary reticular formation, the ventral tegmental cholinergic and noradrene , projection system ascend in the medial forebrain bundle Fig.
Efferent Projections of the Hypothalamus The three major efferent projection systems of the hypothalamus include: I. Reciprocal limbic projections; Polysynaptic projections to autonomic and motor centres in the brainstem and spinal cord; and 3. Neuroendocrine communication with the neurohypophysis and adenohypophysis of the pituitary gland. Learning and Memory ln.
TIle memory process will be explored in an overview fashion here since memory problems are frequently observed in patients with other neurological dysfunctions, and a rudimentary understanding of memory is clinically relevant to their treatment.
Implicif memory, which is the memory we use lO perform a previously learned task and does not require conscious recall, and includes various types of memory such as procedural, prirning, associative, and nonassociative. Procedllml memory is involved with recall of how lO perform previously learned skills or habits. It is thought to rely heavily on areas of the striatum.
Priming is a type of memory in which me recall of words or objeas is enhanced with prior exposure to the words or objeas. This type of mernory utilizes neocortical circuits. Associatille le"nling or memory involves me association of two or more stimuli and includes classical conditioning and operant conditioning Kandel et a1 Classic"f conditioning involves the presynaptic facilitation of synaptic transmission that is dependent on aaivity in both pre- and postsynaptic cells.
The neuron circuit learns lO associate one type of stirnulus with another. When stimuli are paired in this manner the result is a greater and longer li1sting enhancernent. For this forrn of activity-dependent facilitation LO occur, the conditioned and unconditional stimuli must occur al closely spaced intervals in lime.
This occurs in a fashion similar to sensitization due to seroLOnin release described above. Adenylyl cyclase aas as coincidence detector, recognizing molecular response LO both a conditioned stimulus and an unconditional stimulus present simultaneously or within a required space of time.
The postsynaptic component of classical conditioning is a retrograde signallO the sensory neurons that potentiation of the stimulus has indeed occurred. In a simple circuit subjected to classical conditioning. In classical conditioning, as a result of pairing of stirnuli the magnesium plug is expelled.
This gives rise to activation of a variety of retrograde messenger systems that enhance the amount of neurotransmitter released. These signals include: I. Activation o f adenylyl cyclase b y calcium innux conditioned ; 2. Activation of serotonergic receptors coupled to adenylyl cyclase unconditioned ; and 3. Retrograde signal indicating that the postsynaptic cell has been adequately activated by the unconditioned stimulus.
Operant conditioning probably utilizes a similar neurophysiological mechanism as described above for classical conditioning. NOfUlSSocitHille learning or memory occurs when a persoll or neuron is exposed to a novel stimulus either once or repeatedly. This Iype of learning or memory involves the neurophysiological processes of habituation and sensitization of synaptic function, which are important processes in nonassociative learning and memory Kandel el.
This process predominantly occurs at sites in the neuraxis specific for learning and memory storage. Sensitization involves axoaxonic, serotonergic conneaions which activate the G protein, adenylyl cyclase. The process of sensitization can occur in a direct fashion which only involves the pre- and postsynaptic neurons, or in an indirect fashion which involves the participation of interneurons. Memory can be classified into twO distinct, but functionally related systems, based on how the information contained in the memory is stored and retrieved.
Explicif memory, which is the factual recall of persons, places, and things and the understanding of the significance of these things, is more nexible than implicit memory and includes various classifications of memory which include: I. Episodic memory, which involves the recall of events in time and space; and Semantic memory, which involves the recall of facts, words, names, and meanings. Explicit memory involves the process of long-term potentiation of synapses in the hippocampus.
The entorhinal cortex acts as both the primary input and primary output of the hippocampus in this process. The unimodal and polymodal areas of association cortex project to the parahippocampal gynls and the perirhinal conex. Information then nows from the entorhinal cortex to the hippocampus in three possible pathways including the perforant, the mossy fibre, and the Schaffer collateral pathways Kandel et al The perforant pathway projects from entorhinal cortex to granular cells of the dentate gyrus.
The mossy fibre pathway, which contains axons of the granule cdls and nllls to the pyramidal cells in the CA3 region of hippocampus, is dependent on noradrenergic activation of beta-adrenergic receptors, which activate adenylyl cyclase. This pathway is Ilonassociative in nature and can be modified by serotonin. TIle Schaffer collateral pathway consists of excitatory collaterals of the pyramidal cells in the CA3 region and ends on the pyramidal cells in the CA1 region.
LonS tenn memory of explicit nature occurs through multiple sensory components being processed separately in unimodal and multi modal association conices of the parietal, temporal, and frontal lobes. The information then projects to the entorhinal conex and via the perforam pathway to the dentate gyrus and the hippocampus.
From the hippocampus, information nows back to the entorhinal conices Copyrighted Material Functional Neurology for Practitioners of Manual Therapy Ummodal and poIymodal association areas: Frootal, lempoech plosive sounds Baroreceptor reflex efferent limb Digestion 11 Cranial accessory Spinal accessory 12 Hypoglossal Medulla Swallowing Medulla Neck movement-SCM and 1- 6 superior trapezius fibres for Medulla Tongue protrusion and other orientation of head in space movements Observation for deviation, atrophy, and fasciculatiom Speech lingual sounds The Affect of Increased Partial Pressure of Carbon Dioxide PCO, on Neuron Function Increased arterial PC02 exerts its effect via corresponding changes in brain exuacel lular fluid fCF H' ion concentrations.
Carbon dioxide combines with water to eventually produce hydrogen ions II' and bicarbonate ions HCOj-. The following reaction outlines the chemical process involved. Other causes of increased [ I I'J can be buffered by this pathway via the production of bicarbonate ions. Regulation of Blood Pressure Sympathetic imbalances may also arise because of al tered integration in the brainsu. Visceral arrerellls or ascending spinorelicular projections from sa mm ie AO and C fibres promote activation of the rostral ventrolateral medulla, which i ncreases vaSon'lOtor tone i loit el al Ihis al ters the systemic vascular resistance and modulates the systemic blood pressure.
Iiall IE rextbook of medical physiology. In: Neuroanatomy through clinical cases. Sinauer edn. I iolt K, Beck RW. Goldberg MF 1 Participation of prefrontal ment on blood pressure.
If you wish to place a tax exempt order please contact us. Demystifies the clinical results seen in the practice of Functional Neurology and scientifically validates its clinical success. Addresses function rather than pathology, allowing the reader to gain a firm understanding of the neurological processes seen in health and disease. Contains clinical cases which are designed to be read and answered before starting the chapter to allow the reader to gauge their current state of knowledge.
Contains a detailed overview of the concepts relating to our understanding of the development of emotion to demonstrate the link between physical health and the mind. This review had five research objectives, three relating to the type of literature available through this journal, and two in relation to design and methodological aspects of the included studies.
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Designs and Patents Ae. Physical therapy abbreviations are frequently used by PTs and PTAs to denote various movements, devices, viewpoints, anatomical landmarks, surgical procedures, and even professional certifications. There are many different abbreviations floating around out there, and we felt it made sense to create a comprehensive guide to PT shorthand. This article is divided into two sections: clinical terminology and professional terminology.
Here are some of the abbreviations and shorthand terms commonly seen in physical therapy documentation. Keep in mind that abbreviations tend to be facility-specific, and when creating your notes, you should always consider that outside parties might eventually read them. This tool—which is built into WebPT—automatically changes designated abbreviations into their full-text equivalents.
Again, this is not an exhaustive list, and we know the educational opportunities available to PT professionals are always evolving.
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