NERVOUS

SYSTEM
FOHP 111
PHYSICAL THERAPY
1STSEMESTER SY2021-22
DR SONNIE TALAVERA
Nervous system

a group of tissue composed of highly

specialized cells possessing the
characteristics of excitability and
conductivity.

• Central Nervous system

• Brain, spinal cord
• Peripheral Nervous System
• Cranial Nerves(12 pairs)
• Spinal Nerves(31 pairs)
• Autonomic Nervous System
Types of cells in the
nervous system

- the nervous system is composed of

a special tissue containing two
major types of cells.
• Neurons
• the active conducting
element
• Neuroglia
• the supporting elements
CENTRAL
• Central nervous system includes the BRAIN and
NERVOUS SPINAL CORD
SYSTEM • Each division is further divided grossly
• gray matter
• white matter.
Gray Matter

• Nucleus
• Ganglion
Brain

Embryological

Procencephalon/ Forebrain
• Telencephalon
• Diencephalon
Mesencephalon

Rhombencephalus
• Metencephalon
• Myencephalon
 • 78% weight of the brain
• Gyrus
• Fissures
• Longitudinal
• Lateral Sylvian
Cerebrum
• Central sulcus (Rolandic
Fissure)
• Parieto-occipital fissure
• Calcarine Fissure
Cerebrum
Lobes of the Cerebral Cortex
• Frontal lobe
• Center of motor function
and personality
• Parietal lobe
• Center for ordinary sensory
function
• Temporal lobe
• Center of hearing and
olfaction
• Occipital lobe
• Visual center
• Insula( Island of Reil)
Cerebrum

Functional area of the cerebral cortex

• Primary motor area/pre central gyrus
• Voluntary movement
• Pre frontal area
• Foresight , judgement, abstract thinking
• Primary sensory/somesthetic area/post-central gyrus
• Pain, temp, pressure, touch, position and
movement sensation
Sensory and Motor Areas of the
Cerebral Cortex

Figure 7.14

Slide 7.31
Cerebrum

Functional area of the cerebral cortex

• Motor speech area/Broca’s area
• Sensory speech area/ Wernicke’s area
• Auditory/Hearing Area( Transverse gyri of Heschl)
• Visual area
• Olfactory/ smell area
• Taste area
Specialized Area ofthe Cerebrum
 Cerebrum
Basal Ganglia
• Caudate nucleus (medial
portion)
• Lentiform nucleus
(lateral portion)
• Putamen
• Globus pallidus
• Control of motor
function
• Unintetional, unecessary
movement
 • help to plan and control complex
patterns of muscle movement
basal
ganglia • controlling
• relative intensities of the separate
movements
• directions of movements
• sequencing of multiple successive
and parallel movements for
achieving specific complicated
motor goals.
Thalamus
• Located below the
corpus callosum
• Highest subcortical
sensory integrating
system
• All sensory impulses
passes to it except
olfactory
 Hypothalamus
• Where the pitiutary gland is
attached
• Functions in regulation of ;
• Body temperature
• feeding activities
• Concentration
• volume of extracellular fluid
• autonomic nervous system
response
• endocrine function
 • Vermis and hemisphere
• Aids the motor cortex in integration
Cerebellum of voluntary movements
• Injury- loss of coordination of motor
activity
 • MESENCEPHALON
• Connects forebrain to
MIDBRAIN hindbrain
cerebellum

• plays major roles in the timing of motor activities

and in rapid, smooth progression from one muscle
movement to the next

• helps to control intensity of muscle contraction

when the muscle load changes

• controlling necessary instantaneous interplay

between agonist and antagonist muscle groups.
 Pons
• Bridge like structure
Pons & • White matter linking the various
parts of the brain
Medulla
Medulla oblongata
Oblongata • Vital regulatory and reflex center
• Circulatory system, breathing,
swallowing. Vomiting, coughing,
sneezing
 • 1. Control of respiration
• 2. Control of the cardiovascular system
• 3. Partial control of gastrointestinal function
• 4. Control of many stereotyped movements
Role of the of the body
Brain Stem • 5. Control of equilibrium
• 6. Control of eye movements

• brain stem serves as a way station for

“command signals” from higher neural
centers.
• controlling whole-body movement and
equilibrium.
Reticular Formation

• long dendrites of neurons permit input from ascending

and descending pathways-- can influence
• skeletal muscle activity,
• somatic and visceral sensations,
• autonomic
• endocrine systems
• level of consciousness RAS SYSTEM
Functions of the Reticular Formation
• reticular activating system RAS.
• Arousal and the level of consciousness are
controlled
• multiple ascending pathways --thru the reticular
formation-- different parts of the cerebral
cortex(causing a sleeping person to awaken).
• state of consciousness dependent on
continuous relay of sensory to cortex.
Functions of the Reticular Formation

• reticular activating system RAS.

• degrees of wakefulness depend on degree of

reticular activity
• pain sensations strongly increase  degree of
reticular activity--excites the cerebral cortex.
• Acetylcholine key role as excitatory
neurotransmitter
 • play a vital role in emotion, behavior, drive,
and memory.

• influence many aspects of emotional

behavior.
Limbic • particularly of fear and anger and
emotions associated with sexual
System behavior.
• Memory of remote past events
• provide pathways for the integration
/effective homeostatic responses to a
wide variety of environmental stimuli
Functions • via the hypothalamus and its
connections with the outflow of the
of the autonomic nervous system and its
Limbic control of the endocrine system
• influence many aspects of
System emotional behavior.
• particularly of fear and anger and
emotions associated with sexual
behavior.
 • hippocampus
• converting recent memory to long-
Functions of term memory.
• individual being unable to store
the Limbic long-term memory.
System • Memory of remote past events
before the lesion developed is
unaffected.
• anterograde amnesia.
Functions of the Limbic System

• injury to the amygdaloid nucleus and the hippocampus

• produces a greater memory loss than injury to
either one of these structures alone.

• no evidence that the limbic system has an olfactory

function.
Functions of the Limbic System
• various afferent and efferent connections of the limbic
system
• provide pathways for the integration
• effective homeostatic responses to a wide variety
of environmental stimuli.
 Ventricles
• Spaces filled with CSF

1. Lateral ventricle
• Intervertebral
foramen(Foramen of
Monroe)\

2. Third ventricle
• Cerebral aqueduct of
Sylvius

3. Fourth ventricle
• Foramen of Luschka and
Magendie
Meninges
• Protection to the CNS

Pachymeninx
• Dura mater
Leptomeninges
• Arachnoid mater
• Pia mater
Meninges
• Dura mater
• Double-layered external covering
• Periosteum – attached to surface of the skull
• Meningeal layer – outer covering of the brain
• Folds inward in several areas
• Arachnoid layer
• Middle layer/ Web-like
• Pia mater
• Internal layer/surface of the brain
Cerebrospinal fluid
✓ 150ml
✓ Water cushion to the CNS structures
✓ Production by choroid plexus
✓ Absorbed by arachnoid villi
✓ Similar to blood plasma composition
✓ Forms a watery cushion to protect the
brain
✓ Circulated in arachnoid space, ventricles,
and central canal of the spinal cord
Blood Brain Barrier
✓ Includes the least permeable capillaries of the
body
✓ Excludes many potentially harmful substances
✓ Useless against some substances
✓ Fats and fat soluble molecules
✓ Respiratory gases
✓ Alcohol
✓ Nicotine
✓ Anesthesia
 • 45cm long, up to L1 (adult) L3(child)
• Enlargements
• Cervical
• Pelvic
Spinal Cord • Conus medullaris
• Filum terminale
• Cauda equina
Spinal Cord
• Extends from the medulla
oblongata to the region of
T12
• Below T12 is the cauda
equina (a collection of
spinal nerves)
• Enlargements occur in the
cervical and lumbar
regions
• Conus medullaris
• Filum terminale
Spinal Nerves
• Combination sensory and
motor fibers
• 31 pairs
• 8 cervical
• 12 thoracic
• 5 lumbar
• 5 sacral
• 1 coccygeal
• Spinal segment
• Dorsal root/ sensory
• Ventral root/ motor
Spinal Cord Anatomy
• Exterior white mater – conduction tracts
 Spinal Cord Anatomy
• Internal gray
matter - mostly
cell bodies
• Dorsal
(posterior)
horns
• Anterior
(ventral) horns

Slide
Slide
Peripheral Nervous System

• Nerves and ganglia outside

the central nervous system
• Nerve = bundle of neuron
fibers
• Neuron fibers are bundled
by connective tissue
Classification of Nerves

✓ Mixed nerves – both sensory and motor

fibers
✓ Afferent (sensory) nerves – carry impulses
toward the CNS
✓ Efferent (motor) nerves – carry impulses away
from the CNS
Spinal Nerves

• There is a pair of
spinal nerves at
the level of each
vertebrae.

Slide 7.63
• Anterior Rami
• Muscles and skin of anterolateral body
and limbs
• Posterior Rami
• muscle and skin of the back

❑Meningeal Branch
❑Rami communicantes
 • Group of nerve fiber from ventral rami of
Plexuses cervical lumbar and sacral
• Posterior rami don’t form plexuses

Cervical plexus C1C2C3C4

• Supplies back, side of the head, front of
the neck with ordinary sensory fiber
• Important is the Phrenic nerve a motor
fiber
 Spinal Nerves

Figure 7.22a
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 7.64
Plexuses Brachial Plexus C5C6C7C8T1
• Supplies the skin and muscle of
the upper limb
• Radial, ulnar, median nerves

Lumbar Plexus L1L2L3L4

• Femoral nerve supplies muscle
and skin on anterior aspect of the
thigh
• Obturator nerve supplies muscle
and skin on medial aspect of the
thigh
 Sacral Plexus L4L5S1S2S3
Plexuses • Largest nerve and branch- Sciatic nerve
divided into peroneal and tibial nerve

Note: Thoracic spinal nerve don’t form plexuses

• T1-T11 Intercostal Nerve
• T12 Subcostal Nerve
 • Bicep brachii reflex- -C5-6
• Tricep brachii- C6-8
• Brachioradialis tendon reflex- C5-7
• Abdominal superficial reflexes
Segmental • Upper T6-7
innervation • Middle T8-9
• Lower T10-12
• Patellar tendon reflex- L2-4
• Achilles tendon reflex- S1-2
Efferent fiber

• Anterior root
• White rami communicantes
• Paravertebral ganglia (symphatetic trunk)
• Gray rami communicantes
• Spinal nerve
 Splanchnic nerve

• Greater
• 5th-9th throracic ganglia to diaphragm and
celiac plexus
Efferent • Lesser
fiber • 10th -9th ganglia to diaphragm and lower
celiac plexus
• Lowest
• 12th thoracic ganglia and gannglia of renal
plexus
Efferent • Sympathetic trunk
fiber • 2 ganglionated nerve trunks that ends
below as ganglion impar
• 3 ganglia cervix
• 11-12 ganglia thorax
• 4-5ganglia lumbar
• 4-5 ganglia pelvis
Afferent fiber

• Viscera/skin
• Sympathetic ganglia
• White rami communicantes
• Spinal nerve
• Posterior root ganglion
• Connector cell at the brain and sacrum
• Brain-CN III, VII, IX and X
• Sacral ( 2nd -4th )
• Anterior nerve root
• Pelvic splanchnic nerves
• Cranial preganglionic n fiber
• Ciliary, pterygopalatine, submandibular and otic
ganglion

Afferent fiber
Cranial Nerves

• 12 pairs attached to the brain

Purely sensory nerves
• carry impulse s towards brain. Also called
afferent fibers
• cranial nerve I, II, VII
Purely motor nerves
• carry impulses away from the brain. Also
called efferent fibers
• cranial nerve III, IV,VI ,XI, XII
Mixed neves
• Carry both sensory and motor nerve fibers
• cranial nerves V, VII, IX, X
Cranial nerve Action
I Olfactory sernsory:smell

II Optic sensor :sight

III Oculomotor Motor:

to extraocular muscle except lateral
rectus and superior oblique

Parasymphatetic:
sphincter of pupil and ciliary muscle
of lens

IV Trochlear Motor: to superior oblique muscle

 CLINICAL MANIFESTATION
AFFECTED PART OF NERVE VISUAL FIELD DEFECT

Right optic nerve blindness of the right eye

Optic chiasm bitemporal heteronymous hemianopsia

Optic tract L homonymous hemianopsia

Optic radiation to cuneus only L lower quadrantanopsia

Optic radiation to lingual gyrus only L upper quadrantanopsia

Visual area L homonymous hemianopsia

 Extrinsic eye muscles:

• -control movement of the eyeball

MUSCLE ACTION NERVE SUPPLY

Lateral rectus VI Moves eye laterally VI(abducens)

Medial rectus Moves eye medially III (oculomotor)

Superior rectus moves eye upwards and III

medially
Inferior rectus moves eye downwards III
and medially
Inferior oblique moves eye upwards and III
laterally
Superior oblique moves eye downwards IV ( trochlear
and laterally
 V Trigeminal
Opthalmic branch Sensory: upper part of skin face

Maxillary Sensory: middle part of skin face

•
Mandibular branch Motor: muscles of mastication

Sensory: lower part of skin of face

except in region near angle of mandible.

VI Abducens Motor: lateral rectus muscle

VII Facial Motor: muscles of facial expression

VIII Vestibulocochlear
Vestibular Sensory:equilibrium
Cochlea Sensory:hearing
AUDITORY SENSE
Mechanism of Hearing
• within the membranes of the snail like cochlea is the
organ of Corti containing the hearing receptors of
hair cells
 VESTIBULAR SENSE
Receptors:

Cristae Ampullaris
• found in the dilatations of
semiciricular ducts called ampulla
• stimulated by angular acceleration
• contains gelatinous substance called
copula

Macula
• found in the vestibule
• stimulates by linear acceleration
• contains gelatinous substance called
otolithic membrane containing
otoconia, which are calcium
carbonate crystals
IX Glossoharyngeal Motors: stylopharynggeus muscles

Sensory: taste posterior 1/3 of tongue, pharynx,

carotid Sinus and carotid body

• Parasympathetic : parotid gland

X Vagus Sensory: skin of external auditory meatus,

Pharynx, larynx and thoracic and abdominal
visceria

Motor: pharynx and larynx

Parasympathetic: thoracic and abdominal

viscera
XI Accessory Motor:
trapezius and sternocleidomastoid muscles of
pharynx and larynx
XII Hypoglossal Motor: muscle of tongue
Autonomic Nervous System

• efferent peripheral nerves fibers distributed to

smooth muscle, cardiac muscle and glands

Autonomic Subdivisions
• the autonomic nervous system may be divided,
both functionally and structurally into
symphathetic and parasymphathetic nervous
divisions.
Autonomic Functioning
• Sympathetic – “fight-or-flight”
• Response to unusual stimulus
• Takes over to increase activities
• Remember as the “E” division = exercise, excitement, emergency, and
embarrassment

• Parasympathetic – housekeeping activites

• Conserves energy
• Maintains daily necessary body functions
• Remember as the “D” division - digestion, defecation, and diuresis
Sympathetic

• Thoracolumbar
• Divisions of the autonomic nervous system arises from all
the thoracic and the first three lumbar segment of the spinal
cord.
• Generally actions are directed toward mobilizing the body’s
energies for dealing with an increase in activity.
• the more primitive, sometimes exerting amass action fortified by
epinephrine from the adrenal medulla .
Parasympathetic

• Craniosacral
• Divisions of the autonomic nervous system arises from the
third, seventh, ninth, and tenth cranial nerves and from
the second -, third, and fourth sacral segments of the
spinal cord.
• the action of this division conserve body energies
• The parasympathetic system is more advanced structurally
and functionally , and its action are never as generalized as the
sympathetic responses.
 Comparison of Somatic and
Autonomic Nervous Systems

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Figure 7.24 Slide 7.69
CLINICAL
Traumatic Brain Injuries (TBI)
• Concussion
• Slight or mild brain injury
• Bleeding & tearing of nerve fibers happened
• Recovery likely with some memory loss
• Contusion
• A more severe TBI
• Nervous tissue destruction occurs
• Nervous tissue does not regenerate
• Cerebral edema
• Swelling from the inflammatory response
• May compress and kill brain tissue
Traumatic Brain Injuries (TBI)
• Concussion
• Slight or mild brain injury
• Bleeding & tearing of nerve fibers happened
• Recovery likely with some memory loss
Contusion
• A more severe TBI
• Nervous tissue destruction occurs
• Nervous tissue does not regenerate
Cerebral edema
• Swelling from the inflammatory
response
• May compress and kill brain tissue

Subdural hematoma
• Collection of blood below the dura
• Standards for these conditions were
revised in 2004. Please check out TBIs
at Mayoclinic.com for more current
information on diagnostic terminology.
Cerebrovascular Accident (CVA)

• Commonly called a stroke

• The result of a ruptured blood vessel
supplying a region of the brain
• Brain tissue supplied with oxygen from that
blood source dies
• Loss of some functions or death may result
Alzheimer’s Disease
• Progressive degenerative brain disease
• Mostly seen in the elderly, but may begin in
middle age
• Structural changes in the brain include
abnormal protein deposits and twisted
fibers within neurons
• Victims experience memory loss, irritability,
confusion and ultimately, hallucinations
and death
Consciousness
• A conscious person is awake and aware of
himself or herself and the surroundings
• normal consciousness
• reticular formation (in the brainstem)
• cerebral cortex
• reticular formation
• responsible for the state of wakefulness
 • cerebral cortex
• the state of awareness, that is,
the state in which the individual
can respond to stimuli and
interact with the environment.
• Drugs that produce
unconsciousness
Consciousness • Anesthetics
• selectively depress the
reticular alerting mechanism
• those that cause wakefulness have a
stimulating effect on this
mechanism.
Consciousness

• different stages of consciousness

• lethargy, stupor, and coma (unconsciousness)
• lethargic
• speech is slow, and voluntary movement is
diminished and slow
• movement of the eyes is slow.
Consciousness

• stupored patient
• will speak only if stimulated with painful stimuli.
• voluntary movements are nearly absent
• eyes are closed, and there is very little spontaneous
eye movement
• deeply stupored patient
• will not speak
• mass movements of different parts of the body in
response to severe pain
• eyes will show even less spontaneous movement.
Consciousness

• unconscious patient
• will not speak and will respond only reflexly to
painful stimuli, or not at all
• the eyes are closed and do not move.
• Clinical example
• intracranial bleeding pass progressively from
consciousness to lethargy, stupor, and coma,
• if recovery occurs, pass in the reverse direction.
 • person can have an intact reticular
formation but a nonfunctioning
cerebral cortex
• person is awake (i.e., the eyes are
open and move around) and has
Persistent sleep–awake cycles
Vegetative • person has no awareness and,
therefore, cannot respond to
State stimuli such as a verbal
command or pain
• known as a persistent
vegetative state
• seen following severe head
injuries or an anoxic cerebral
insult.
Sleep
• Sleep is a changed state of
consciousness
• pulse rate, respiratory rate,
and blood pressure fall
• the eyes deviate upward
• pupils contract but react to
light
• tendon reflexes are lost
• plantar reflex may become
extensor
Sleep

• not, however, unconscious, because he or she

may be awakened ---cry of a child or
background noise of an air-conditioner.
• Sleep
• facilitated by reducing the sensory input
and by fatigue---decreased activity of the
reticular formation and the thalamocortical
activating mechanism..
Epilepsy

• symptom in which there is a sudden transitory

disturbance of the normal physiology of the brain,
usually the cerebral cortex, that ceases spontaneously
and tends to recur
• associated with a disturbance of normal electrical
activity
• most typical form, is accompanied by seizures
 • partial seizures
• abnormality occurs in only
one part of the brain and
the patient does not lose
consciousness
• generalized seizures
Epilepsy • abnormal activity involves
large areas of the brain
bilaterally, and the
individual loses
consciousness.
Epilepsy

• generalized seizures
• Minority --nonconvulsive attacks, in which the
patient suddenly stares blankly into space.
• referred to as petit mal
• majority --sudden loss of consciousness, and there
are tonic spasm and clonic contractions of the
muscles
• transient apnea and often loss of bowel and
bladder control
• convulsions usually last from a few seconds to a
few minutes.
 • Postural Changes and Alteration of Gait
• head is often rotated and flexed, and
the shoulder on the side of the lesion
is lower than on the normal side.
cerebellar • patient assumes a wide base when he
dysfunction. or she stands and is often stiff legged
to compensate for loss of muscle tone.
• individual walks, he or she lurches and
staggers toward the affected side.
 • Disturbances of Voluntary
Movement (Ataxia)
• muscles contract irregularly and
weakly.
• Tremor occurs when fine
cerebellar movements, such as buttoning
dysfunction. clothes, writing, and shaving,
are attempted.
• Muscle groups fail to work
harmoniously
• decomposition of
movement.
 • Disturbances of Voluntary
Movement (Ataxia)
• patient is asked to touch the tip
of the nose with the index
finger, the movements are not
properly coordinated, and the
cerebellar finger either passes the nose
dysfunction. (past-pointing) or hits the nose.
• similar test can be
performed on the lower
limbs by asking the patient
to place the heel of one foot
on the shin of the opposite
leg.
cerebellar dysfunction.

• Dysdiadochokinesia
• inability to perform alternating movements
regularly and rapidly.
• Ask the patient to pronate and supinate the
forearms rapidly.
• On the side of the cerebellar lesion, the
movements are slow, jerky, and incomplete.
cerebellar dysfunction.

Disturbances of Ocular Movement

• Nystagmus,
• ataxia of the ocular muscles, is a rhythmical
oscillation of the eyes.
• easily demonstrated when the eyes are deviated in
a horizontal direction.
• rhythmic oscillation of the eyes may be of the
same rate in both directions (pendular
nystagmus)
•.
 • Nystagmus,
• quicker in one direction than in
the other (jerk nystagmus).
Symptoms
• slow phase away from the
and signs are visual object, followed by a
characteristic quick phase back toward the
of cerebellar target.
dysfunction. • The quick phase is used to
describe the form of
nystagmus. For example, a
patient is said to have a
nystagmus to the left if the
quick phase is to the left and
the slow phase is to the right.
 Loss of • damage to the reticular
Consciousness formation, which spares the
ascending sensory pathways,
causes persistent
unconsciousness.
• Pathologic lesions -- loss of
consciousness and even coma.
• loss of consciousness that occurs in
epilepsy
• inhibition of the activity of the
reticular formation in upper part
of diencephalon.
 • chronically disordered thinking
• blunted affect
• emotional withdrawal
Schizophrenia • Paranoid delusions
• auditory hallucinations
Schizophrenia • limbic receptors to dopamine are
blocked by a pharmacologic agent,
the worst symptoms of schizophrenia
are lessened.

• Phenothiazine administration--
blocks the dopamine receptors in
the limbic system.
Amygdaloid • Unilateral or bilateral destruction of
the amygdaloid nucleus and the para-
Complex amygdaloid area in patients suffering
from aggressive behavior results in a
decrease in theff
• Aggressiveness
• emotional instability
• Restlessness
• increased interest in food
• hypersexuality
• no disturbance in memory.
Amygdaloid • Klüver-Bucy syndrome.
• docile and show no evidence of
Complex fear or anger
• unable to appreciate objects
visually
• increased appetite
• increased sexual activity.
 Temporal • Temporal lobe epilepsy
• preceded by an aura of acoustic or
Lobe olfactory experience.
Dysfunction • olfactory aura is usually an
unpleasant odor.
• patient is often confused, anxious,
and docile and may perform
automatic and complicated
movements, such as
• undressing in public or driving
a car,
• following the seizure, may
have no memory of what
occurred previously.
Development Aspects of the Nervous
System

✓ The nervous system is formed during the

first month of embryonic development
✓ Any maternal infection can have extremely
harmful effects
✓ The hypothalamus is one of the last areas
of the brain to develop
Development Aspects of the Nervous
System

✓ No more neurons are formed after birth,

but growth and maturation continues for
several years (new evidence!)
✓ The brain reaches maximum weight as a
young adult
✓ However, we can always grow dendrites!
END