1 / 96

Nervous System

Nervous System . Pathological Conditions. Functions CNS : 1. Helps maintain homeostasis 2. Responsible for: a. Mental processes b. Behaviors c. Emotional responses. Function PNS: ~ Transmit electrical impulses to and from central nervous system (CNS) (sensation and motor control)

sonja
Download Presentation

Nervous System

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Nervous System Pathological Conditions

  2. Functions CNS: • 1. Helps maintain homeostasis • 2. Responsible for: • a. Mental processes • b. Behaviors • c. Emotional responses

  3. Function PNS: • ~ Transmit electrical impulses to and from central nervous system (CNS) (sensation and motor control) • Interconnecting neurons in CNS provide for • Consciousness, learning, creativity, memory (outside this scope)

  4. Structure: • ~ Each neuron has axon, cell body, dendrite • Peripheral nerves = bundles of axons and dendrites • Sensory neurons: long dendrites, cell body in dorsal root ganglion (DRG), short axons • Motor neurons: long axons, cell body and short dendrite in ventral horn of spinal cord • All motor neurons terminate in muscle or glandular tissue • ~ Neurons communicate at synapses, using neurotransmitters

  5. REFLEX ARC - picture this page

  6. THE NEURON

  7. NEURON COVERINGS • Myelin in CNS and peripheral nervous system (PNS): Schwann cells (PNS) and oligodendrocytes (CNS) • ~ Speeds transmission, electrical insulation • ~ Neurilemma in CNS only • ~ Promotes repair of PNS tissue • Most PNS nerves run close to bone for protection • ~ Vulnerable in a few places (endangerment sites)

  8. SYNAPSE Pre-synaptic Neuron Post-synaptic Neuron

  9. FUNCTIONS OF THE NERVOUS SYSTEM Sensory function: receptors detect stimuli and respond by sending information to the CNS Integration function: CNS integrates this information and decides on a response Motor function: motor neurons carry impulses from the CNS to the muscles and glands

  10. CENTRAL NERVOUS SYSTEM Brain: Housed in skull Spinal cord: Housed in vertebral column Both brain and spinal cord protected by meninges and cerebrospinal fluid and bone, lots of bone!

  11. SPINAL CORD AND NERVES

  12. Major Parts of Human Brain Brainstem Cerebellum Diencephalon Cerebrum

  13. PERIPHERAL NERVOUS SYSTEM • Somatic nervous system: • Consciously controlled (voluntary) • Autonomic nervous system: • Not consciously controlled (involuntary) • Divided into parasympathetic and sympathetic nervous systems

  14. AUTONOMIC NERVOUS SYSTEM • Parasympathetic • Rest-and-digest • Sympathetic • Fight-or-flight

  15. GENERAL NEUROLOGICAL PROBLEMS • Many disorders involve mechanical impairment of nerve function: compression or distortion • Massage may aggravate or relieve pressure • Brain and spinal cord injuries are inaccessible • Patients can benefit from massage to maintain function • Proprioceptive adaptation may be subject to interruption • Psychological disorders are a different class • May benefit from massage for stress balance • Risk of interpersonal complications

  16. GENERAL NEUROLOGICAL CAUTIONS • MAJOR CAUTIONS FOR MASSAGE THERAPISTS: • Numbness (more dangerous than pain) • Verbal communication(watch for nonverbal signals) • Medications (may have interactions with massage)

  17. NERVOUS SYSTEM CONDITIONS Chronic Degenerative Disorders: Alzheimer disease Amyotrophic lateral sclerosis Multiple sclerosis Peripheral neuropathy Movement Disorders Dystonia Parkinson disease Tremor Infectious Disorders Encephalitis Herpes zoster Meningitis Polio, postpoliosyndrome Psychiatric Disorders Anxiety disorders Attention deficit hyperactivity disorder Autism spectrum disorder Chemical dependency Depression Eating disorders

  18. NERVOUS SYSTEM CONDITIONS, CONT. Other: Guillain-Barré syndrome Headaches Ménière disease Seizure disorders Sleep disorders Vestibular balance disorders Nervous System Injuries: Bell palsy Cerebral palsy Complex regional pain syndrome Spina bifida Spinal cord injury Stroke Traumatic brain injury Trigeminal neuralgia

  19. CNS Disorders Cerebral palsy Spina bifida Seizure disorders Spinal cord injury Attention deficit-hyperactivity disorder 6. Autism

  20. CEREBRAL PALSY ~ Group of motor disorders; damage to cerebrum from inadequate or reduced blood flow ~ Lighter pressure; avoid joint mobilizations or administer carefully; instruct parents to massage if affected person is a child

  21. CEREBRAL PALSY • Definition • Group of brain injuries that happen during gestation, birth, early infancy • Signs and Symptoms • Vary, depending on type, area of brain damage • Hypotonicity, hypertonicity, poor coordination, poor control, weak muscles, random movements, etc.

  22. CEREBRAL PALSY • Treatment • Skills, equipment to live as functionally as possible: • Braces, other aids • OT, PT, speech therapy • Adapted computers • Extensive massage/physical therapy may yield surprising results: interferes with proprioceptive limitations • Medication: • Antiseizure, reduce muscle spasm, Botox for excessive salivation, involuntary muscle contractions • Surgery for dislocations, bone corrections

  23. CEREBRAL PALSY: cont’d • Massage: • Many benefits: • ~ can work with proprioceptors to increase ROM, maintain function • ~ Be careful about communication, nonverbal signals for people who can’t speak clearly

  24. SPINA BIFIDA • Definition • - Cleft spine: neural tube defect in which the vertebral arch fails to close completely over the spinal cord • - Ranges from subtle to severe • Spina bifida occulta (SBO) • - Vertebral arch may not completely fuse; no signs are visible • - May not know until radiography for something else • - May be common: 5–10% of population? • - May show dimple, tuft of hair at low back • - Can be serious: tethered cord

  25. Spina bifida meningocele • ~ Rarest form • ~ Only dura, arachnoid press through cleft to form a cyst visible at birth • ~ Repaired with surgery, few long-term consequences • Spina bifida myelomeningocele • ~ Most common, most serious diagnosed form: 94% all cases • ~ Caudaequina protrudes with meninges through cleft • ~ Skin may or may not cover cyst (risk of CNS infection)

  26. Complications • ~ 85% of patients have hydrocephalus • Treated with a shunt • ~ Some may have cognitive impairment • ~ Latex hypersensitivity can become dangerous • ~ Decubitus ulcers, GI problems, urinary problems, obesity, muscle imbalances, scoliosis • Treatment • ~ Surgery to reduce cyst within a few days of birth • ~ PT to retain function, build leg muscles • ~ Assistive equipment as necessary • ~ Additional surgeries to release tethered cord, deal with hydrocephalus, etc.

  27. SPINA BIFIDA

  28. Massage: • ~ Depends on sensation, level of function, other complications • ~ Can be helpful in the context of PT to promote good function

  29. Spasticity, contractures • ~ Some is related to CNS damage • ~ Can be reinforced by proprioceptive messages • (Some of this may be interruptible with PT, massage) • ~ Damaged sensation may → painful temporary spasms)

  30. Treatment: • ~ Acute: remove pressure on spinal cord • ~Limit inflammation, secondary damage • ~ Later: • ~Implant electrodes in muscles; surgical transfer of healthy tendons, work with spinal reflexes • ~Work to provide living skills • ~New branches of research: influence growth medium in CNS for regeneration of damaged cells • Massage: • Respect complications • Otherwise indicated for improved function, pain relief, proprioceptive training

  31. Seizure Disorder

  32. First-Aid for Seizures Remain calm and begin to time seizure Clear area of objects Gently place person on floor (if possible) Place soft material or cushion under head; lift chin slightly to open airway Roll on side if choking or vomiting Remain with person until seizure has ended

  33. First-Aid for Seizures (cont’d.) • If seizure lasts more than 5 minutes or immediately repeats, call 911, then: • Talk calmly to person until help arrives • Inform medical personnel how long seizure occurred and symptoms exhibited • Write incident report • If no medical help is called, make certain that person does not attempt to drive home along. Seizure leaves disorientation. Call relative or friend. • Massage • Contraindicated during seizure; consult with client for best strategies • Other times massage is fine

  34. Attention Deficit Hyperactivity Disorder • Definition • Neurobiochemical disorder → difficulties with attention, movement, impulse control • Demographics • Estimates only 4.3% school-age children • (= 4.4 million) in the United States • - Some surveys show higher, lower numbers • May be both overdiagnosed and underdiagnosed • - Boys > girls 2.5:1; may not be accurate • 30–75% of children with ADHD have it as adults • They may raise kids with ADHD

  35. Attention Deficit Hyperactivity Disorder • Massage • Indicated: may improve classroom behavior, interpersonal relationships • May need to adjust length of session

  36. AUTISM SPECTRUM DISORDERS • Definition • Communication disorders • Specific, predictable movement patterns • Sensory problems • Usually begins early in childhood; diagnosable by age 3 • Also called pervasive developmental disorders (PDD) • Demographics • Three to four in 1,000 school-aged children • Number is rising; unclear why

  37. Autism Spectrum Disorders, cont. • Signs and Symptoms • Three major issues: • Deficit in verbal and nonverbal communication • Problems with social interactions • Repetitive behaviors, movements • Sometimes: extreme reactions to sensory stimuli • Locked inside perspective: no understanding of other consciousness • No interpretation of voice or tone • People seem completely unpredictable

  38. Autism Spectrum Disorder: Syndrome of social withdrawal and obsessive behavior; five types ranging from mild and highly functional to severe Reduce treatment time; use firm gliding and compressive strokes with full hand contact; instruct parents to massage if affected person is a child ● Asperger syndrome is the most common type and is a mild form of autism. 1. People with Asperger have difficulty parsing social cues and conventions. They cannot relate on an emotional level and have great difficulty reading the emotions of others.

  39. Types of autism spectrum disorders: • 1. Autistic disorder • 2. Asperger syndrome • 3. PDD-NOS: pervasive developmental disorder, not otherwise specified • 4. Rettsyndrome: note below • 5. Childhood disintegrative disorder: see note below • Massage: • - Can be helpful • Improves sleep, more positive social interactions, more time on task • - Some may not tolerate touch: requires adjustments from therapist

  40. Depression: an affective disorder • Definition: • A genetic-neurochemical disorder requiring a strong environmental trigger whose characteristic manifestation is an inability to appreciate sunsets.

  41. Treatment: also see below • -> Most types are treatable • - Can be challenging to find right combination, dosage • - Important to treat fully to decrease risk of repeat episodes • Massage • Benefits: • - Improves HPA axis function • - Parasympathetic balance • Increase in serotonin, decrease in cortisol • - Shift in mood state • - Self-care • Risks: • - Clients may want to stop taking meds • - Complex emotional issues, high risk for boundary confusion

  42. Spinal cord injury • Definition • ~ Self-evident • ~ Concussion, contusion, compression, laceration, transaction • ~ Paraplegia, tetraplegia, quadriplegia

  43. Signs and Symptoms: • ~ Higher the lesion → more damage • ~ Anterior cord → motor damage • ~ Posterior, lateral cord → sensory damage • Complications: • ~Respiratory infection • Especially if injury is above T12; leading cause of death for SCI patients is pneumonia • ~Deep vein thrombosis, pulmonary embolism • Pulmonary embolism is number 2 cause of death for SCI patients • ~Urinary tract infection • Neurogenic bladder, catheter use carries high risk of urinary tract infection (UTI), kidney infection

  44. Decubitus ulcers: • High risk for infection, blood poisoning • Heterotopic ossification: • Usually around hips, knees; can be painful • Corrected surgically • Autonomic hyperreflexia : • Especially with damage above T6 • Minor stimulus creates sympathetic reaction: pounding headache, increase heart rate, high blood pressure; can be medical emergency • Cardiovascular disease: • Related to immobility • Numbness: • Allows minor injuries to be ignored; risk of infection • Pain: • From damaged nerve tissue, secondary injury, heterotopic ossification, musculoskeletal injury

  45. Spinal Cord Injury • Damage to the vertebrae and neural tissues causing loss of movement (paralysis) and loss of sensation distal to area of insult • Paraplegia: paralysis of the lower extremities and trunk • Quadriplegia: paralysis of the trunk and all extremities • Medical clearance is needed • Some of the common problems with SCI: bladder and bowel incontinence, decubiti, atrophy, extraneous medical equipment.

  46. Spinal Cord Injury (cont’d.) Depending on the level of the spine the injury occurs at, there will be more or less paralysis and parasthesia.

  47. TYPES OF INJURY TO SPINAL CORD FLEXION INJURY is also known as “Whiplash.”

  48. Attention Deficit-Hyperactivity Disorder (ADHD) Array of behaviors associated with inattentiveness, hyperactivity, impulsivity, or combination of these Reduce treatment time; instruct parents to massage if affected person is a child ● The therapist will most likely face challenging situations when working with adults who have ADHD. These range from excessive fidgeting and talking during the massage to missed appointments and forgotten wallets. Be tolerant on one hand and, and the other hand, too much tolerance may lead to unenforced office policies.

  49. Wheelchair-Bound Clients • Maintain eye level during intake interview • Inquire about any medications and their side effects such as drowsiness • If indicated, use stimulating strokes at the end of session and ask client to move slowly and carefully • Observe wheelchair etiquette • ● Never push a wheelchair without permission from the person in the chair. Never assume a wheelchair-bound client is helpless; let them direct you if they need any assistance.

  50. Wheelchair-Bound Clients (cont’d.) Avoid skin lesions such as bedsores Use light to moderate pressure depending on sensation level Trigger points are often located in shoulders and chest area Limit ROM exercises, especially on neck, spinal column, and hip joints If you do not understand: ASK.

More Related