Neurologic system

- frontal lobe = personality, behavior, emotions, and intellectual function. -parietal lobe = postcentral gyrus is the primary center for sensation - occipital lobe = primary visual receptor center - temporal lobe = behind the ear and primary auditory reception center - Wernicke's = in the temporal lobe, language comprehension (damage = receptive aphasia = can hear bla bla bla) - broca's in frontal lobe, mediates motor speech (damage = expressive aphasia = can understand but can't say it)

-basal ganglia = control automatic associated movements of the body, the arm swing alternating with the legs during walking - thalamus = main relay station for the nervous system, - hypothalamus = major control center with many vital functions: temp, HR, BP, sleep center, anterior and posterior pituitary gland regulator, and coordinator of autonomic nervous system activity and emotional status. - cerebellum= concerned with motor coordination of Voluntary movements, equilibrium, and muscle tone (doesn't initiate movement but smoothes it. coordinates many muscles piano, swim, juggle, like a autopilot. corrects voluntary movement under conscious level)

-midbrain= merges into thalamus and hypothalamus. contains many motor neurons and tracts -pons= the enlarged area containing ascending and descending fiber tract -medulla= the spinal cord in the brain that contains all ascending and descending fiber tracts. it has vital autonomic venters: resp, heart, GI fn, as well as nuclei for cranial nerves VIII through XII. pyramidal decussation (crossing of the motor fibers) occurs here (gag, cough, hickupin, autonomic) -spinal cord= main high way for ascending and descending fiber tracts that connect the brain to the spinal nerves, Mediates reflexes.

-spinothalamic tract= medaites pain temp, and crude or light touch (not precisely localized) (lateral spinothalmaic tract = pain, temp) (anterior spinothalamich tract= crude touch) -posterior (dorsal) columns= sensation of position, vibration, and Fine localized touch (identify objects just by touch)

-corticospinal/pyramidal tract= "higher" motor system for purposefull and skilled movements (writing) -extrapyramidal tracts= "lower" or primitive movemets (walking -cerebellar system= coordinates movements, maintains equillibriam and helps maintain posture

-upper= located in CNS and are the descending fibers that influence/modify the lower motor neurons. conveys impulses form cerebral cortex to the lower... -lower=located in the PNS cell body in gray matter of spinal cord, nerve fiber extends to directly connects to the muscles (the "final common pathway")

1. an intact sensory nerve (afferent) 2. a functional synapse in the cord 3. an intact motor nerve fiber 4. the neuromuscular junction 5. a competent muscle

HA, head injury, dizziness/verdigo, seizures, tremors, weakness, incoordination, numbness/tingling, difficulty swallowing, difficulty speaking, significant past history, and environmental/occupational hazards.

-I olfactory= identify familiar odor -II optic= visual acuity, visual fields (confrontation), shine light in eye (light reflex test), direct inspection. -III oculomotor= inspection, extraocular muscle movement, shine light in eye. -IV trochlear= extraocular muscle movement (move eyes down or out ward) -V trigeminal= superficial touch/sensory function (absent touch, pain, paresthesias), corneal reflex, clench teeth. -VI Abducens= extraocular muscle movement to right and left sides -VII Facial= wrinkle forehead, close eyes tightly, smile, puff cheeks identify tastes

-VIII acoustic= hearing acuity -IX glossopharyngeal= gag reflex -X Vagus= phonates "ahh", gag reflex, note coice quality, and swallowing -XI Spinal accessory= turn head, shrug shoulders against resistance -XII Hypoglossal= protrude tongue wiggle tongue from side to side

-gait/ tandem walking -rombers test - stand feet together with eye closed for 20 seconds.. or shallow knee bend. -rapid alternating movements

-pain= poke w/ dull or sharp tung blade. pt says dull/sharp - temp= hot/cold water or tuning fork -touch= touch pt with stretched out cotton ball, test bilaterally - vibration= place tuning fork on toe/finger, if no, move up leg/arm -position= move a finger up or down and pt will tell you the direction you moved their finger.

4= very brisk, hyper active w/ clonus, indicative of disease 3= brisker han average, may indicate disease 2= average, normal 1= diminished, low normal 0= no response

-biceps reflex C5-C6 -triceps reflex C7-C8 -bachioradialis reflex C5-C6 -quadricepts reflex L2-L4 -achilles reflex L5-S2

1. level of consciousness 2. motor function 3. pupillary response 4. vital signs

-eye opening -motor response -verbal response

arm is immobile against the body, with flexion of the shoulder, elbow, wrist, fingers, and adduction of shoulders. the leg is stiff and extended and circumducts with each step (drag toe in a semicircle)

staggering, wide-based gait; difficult with turns; ncoordinated movement with positive rombergs sign

posture is stooped; trunk is pitched forward; elbows hips and knees are flexed. steps are short and shuffling. hesitation to begin walking, and difficult to stop suddenly.the person holds the body rigid. walks and turns body as one fixed unit. difficulty with any change in direction

knees ross or are in contact, like holding an orange between the highs. the person uses short steps, and walking requires effort

slapping quality- looks as if walking up stairs and finds no stair there. lifts knee and foot high and slaps it down hard and flat to compensate for foot drop

weak hip muscles- when the person takes a step, the opposite hip drops, which allows compensatory lateral movement of pelvis. often the person also has marked lumbar lordosis and a protruding abdomen

- upper= hyperreflexia, ankle clonus; diminished or absent superficial abdominal reflexes; positive babinski sign - lower= hyporeflexia or areflexia; no babinski's sign, no pathologic reflexes

snout = gently percuss oral region (bad= lips pucker) sucking = touch oral region (Bad = sucking movement of lips, tongue,jaw, swallowing grasp = touch palm with our fingers (bad = uncontrolled, forced grasping)

difficulty speaking

hypothalamus

place a coin in the person's hand and ask him or her to identify it.

S2

reinforcement

coordination- hop on one foot

stroke the lateral aspect of the sole of the foot from heel to the ball

dorsiflextion of the big toe and fanning of all toes

is positive when the ipsilateral testicle elevates upon stroking the inner aspect of the thigh

offer the baby a bottle

rigidity and weakness of voluntary movement

slow, monotonous

I, smell

II, vision

III, extraocular movement, pupil constriction, down and inward movement of the eye

IV, down and inward movement of the eye

V, mastication and sensation of face, scalp, cornea.

VI, lateral movement of the eyes

VII, taste anterior two thirds of tongue, close eyes

VIII, dearing and equilibrium

IX, phonation, swallowing, taste posterior third of tongue

X, talking, swallowing, carotid sinus, and carotid sinus, and carotid reflex

XI, movement of trapezius and sternomastoid muscles

XII, movement of the tongue.