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International Standards For Neurological and Functional Classification of Spinal Cord Injury
International Standards For Neurological and Functional Classification of Spinal Cord Injury
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WHO Library Cataloguing-in-Publication Data
International perspectives on spinal cord injury / edited by Jerome Bickenbach .
International Perspectives
on Spinal Cord Injury
World Health Organization 2013
Estimated global SCI incidence is 40 to 80 new
cases per million population per year, based on
quality country-level incidence studies of spinal
cord injury from all causes. This means that
every year, between 250 000 and 500 000 people
become spinal cord injured.
NERVOUS SYSTEM
How animals progressed from a simple nerve net to a complex centralized nervous system remains
one of the most exciting and unsolved questions of animal evolution.
Neurons exhibit the cytological
characteristics of highly active secretory cells with
large nuclei; large amounts of smooth and rough endoplasmic
reticulum; and frequent clusters of specialized
smooth endoplasmic reticulum (Golgi apparatus), in
which secretory products of the cell are packaged into
membrane-bound organelles for transport out of the
cell body proper to the axon or dendrites
Neurons are highly polarized cells, meaning that
they develop distinct subcellular domains that subserve
different functions. Morphologically, in a typical
neuron, three major regions can be defi ned: (1) the cellbody (soma or perikaryon), which
contains the nucleus
and the major cytoplasmic organelles; (2) a variable
number of dendrites, which emanate from the perikaryon
and ramify over a certain volume of gray
matter and which differ in size and shape, depending
on the neuronal type; and (3) a single axon, which
extends, in most cases, much farther from the cell body
than the dendritic arbor (Fig. 3.1). Dendrites may be
spiny (as in pyramidal cells) or nonspiny (as in most
interneurons), whereas the axon is generally smooth
and emits a variable number of branches (collaterals).
In vertebrates, many axons are surrounded by an insulating
myelin sheath, which facilitates rapid impulse
conduction
Synapses
Each synapse is a complex of several components:
(1) a presynaptic element, (2) a cleft, and (3) a postsynaptic
element. The presynaptic element is a specialized part
of the presynaptic neurons axon, the postsynaptic
element is a specialized part of the postsynaptic
somatodendritic membrane, and the space between
these two closely apposed elements is the cleft. The
portion of the axon that participates in the axon is the
bouton, and it is identifi ed by the presence of synaptic
vesicles and a presynaptic thickening at the active
action potential. Neurons and glia share the complement of organelles found in all
cells, including the endoplasmic reticulum and Golgi apparatus, mitochondria,
and a variety of vesicular structures
The chemical and electrical process by which the information encoded by action
potentials is passed on at synaptic contacts to the next cell in a pathway is called
synaptic transmission. Presynaptic terminals (also called synaptic endings, axon
terminals, or terminal boutons) and their postsynaptic specializations are
typically chemical synapses, the most abundant type of synapse in the nervous
system
Neurons never function in isolation; they are organized into ensembles or
neural circuits that process specific kinds of information and provide the
foundation of sensation, perception and behavior. The synaptic connections
that define such circuits are typically made in a dense tangle of dendrites,
axons terminals, and glial cell processes that together constitute what is
called neuropil
Nerve cells that carry information toward the brain or spinal cord (or farther centrally
within
the spinal cord and brain) are called afferent neurons; nerve cells that carry
information away from the brain or spinal cord (or away from the circuit in