perception and coordination lecture notes

1. PERCEPTIOh &
COORDIhATIOh
Overview of
Anatomy & Physiology
Perception & Coordination

2. Perception & Coordination
NEUROSENSORY
SYSTEM
NERVOUS SYSTEM
1. CENTRAL NERVOUS SYSTEM
a. Brain
b. Spinal cord
2. PERIPHERAL NERVOUS SYSTEM
a. Cranial Nerves
b. Spinal Nerves
c. Autonomic Nervous System
SENSORY ORGANS

3. The Brain
■ Cerebrum
□ 2 hemispheres/ 4 lobes
□ Corpus callosum
□ Basal ganglia
■ Diencephalon
□ Thalamus
□ Hypothalamus
■ Brain stem
□ Midbrain, pons, medulla
■ Cerebellum
hypothalamus
Corpus callosum
thalamus
Perception & Coordination

4. ■ Frontal lobe
□ Personality, behavior
□ Higher intellect
□ Precentral gyrus: motor fxn
□ Broca’s area: specialized
motor speech area
■ Parietal lobe
□ Postcentral gyrus: general
sensation
□ Integrates sensory info
■ Temporal lobe
□ Hearing, smell, taste
□ Wenicke’s area: sensory
speech area
■ Occipital lobe
□ Vision
Cerebrum
Perception & Coordination

5. The Spinal Cord
■ Gray matter
□ Anterior horns
□ Posterior horns
□ Lateral horns
■ White matter
□ Ascending tracts
□ Descending tracts
Perception & Coordination

6. ■ Axon
□ Transmit impulses away from
cell body
■ Dendrites
□ Receive impulses
■ Synapse
□ Junction bet. neurons where
impulse is transmitted
■ Myelin sheath
□ Protect & insulate; enhance
impulse conduction
The Neuron
■ Neurotransmitters
□ Chemical agents involved in
transmission of impulse
across synapse Nucleus of
Schwann cells
Terminal branches
of axon
Perception & Coordination

7. The Re{lex Arch
Perception & Coordination

8. Neurotransmitters
EXCITATORY INHIBITORY
Acetylcholine –triggers muscle contraction
stimulates hormone excretion
(Lack : Alzheimer’s dse)
Epinephrine –initiates fight or flight responses
Norepinephrine –affects mood & overall activity
for attentiveness & learning
(lack: Mood dlo – depression)
Glutamic Acid –for learning & memory
(assoc: Alzheimer’s dse)
Enkephalin– pleasurable sensations,
Endorphin inhibits pain transmission
GABA ( Gama Amino Butyric Acid )
– for motor control and vision
Serotonin – inhibits pain pathways
regulates temp, appetite,
mood
(imbalance: suicide
aggressiveness)
Dopamine –affects behavior
(attention, emotions)
controls fine movement
(Loss: Parkinson’s disease)
Acetylcholinesterase
– inhibits acetylcholine
Perception & Coordination

9. Perception & Coordination
Supporting Structures
■ Skull
■ Spinal/ vertebral column
■ Meninges
■ Ventricles
■ Cerebrospinal fluid (CSF)
■ Blood-brain barrier (BBB)
■ Vascular supply

10. Coronal suture
Skull Sagittal suture
Lambdoidal suture
Squamosal suture
Perception & Coordination

11. Vertebral Column
7 cervical
12 thoracic
5 lumbar
Sacrum
Coccyx
Perception & Coordination

12. Meninges
EPIDURAL SPACE
SUBARACHNOID SPACE
Perception & Coordination

13. Perception & Coordination
Ventricles

14. on
n
CSF
■ Clear, colorless fluid
■ Specific gravity = 1.007
■ Total production = 400-
500 mllday
■ Normal resting pressure
= 150-180 mm H2O.
■ Contents = albumin,
Glucose, chloride, lactic
acid, Glutamine, IgG,
protein, WBC trace
HYDROCEPHALUS
Taken: August 11, 2004
DMC Pedia Ward
VP – SHUNT
(VENTRICULO-
PERITONEAL)
Perception & Coordinati

15. Perception & Coordination
BBB

16. Perception & Coordination
FUNCTIONS OF THE BBB
■ Protects the brain from "foreign
substances" in the blood that
may injure the brain.
■ Protects the brain from hormones
and neurotransmitters.
■ Maintains a constant
environment for the brain.

17. Occlusion of blood flow = irreversible tissue damage
Cerebral Circulation
Cerebral Circulation = 15% of Cardiac Output
750 ml of blood passes through the brain each minute
Collateral Circulation – provides blood to brain tissue
Circle of Willis – ring of arteries formed at base of brain
Perception & Coordination

18. Perception & Coordination
Peripheral Nervous System
•CRANIAL NERVES
•SPINAL NERVES
•AUTONOMIC NERVOUS SYSTEM

20. I
II
OLFACTORY
OPTIC
S
S
Sense of smell
Central & Peripheral vision
III OCULOMOTOR M Eye mvmt, elevation of eyelid
IV TROCHLEAR M Downward & inward eye mvmt
V TRIGEMINAL B-S
-M
Touch,pain, temp, jaw & eye mus
Mastication
VI ABDUCENS M Abduction of eye
VII FACIAL B-M
-S
closed eyelid, mus of facial exp
taste ( ant 2l3 of tongue )
VIII ACOUSTIC S Equilibrium (Vestib), Hearing (Coch)
IX GLOSSOPHARYNGEAL B-M
-S
Movemt of pharyngeal muscles
Pharyngeal & post tongue sensatn
X VAGUS B-M
-S
Pharyngeal & laryngeal mvmt
P & L sensation, taste
XI SPINAL ACCESSORY M sternocleidomastoid, trapezius mvt
XII HYPOGLOSSAL M Tongue Movement
Perception & Coordination

21. Spinal Nerves
Perception & Coordination

22. 31 segments:
8 cervical,
12 thoracic,
5 lumbar,
5 sacral and
1 coccygeal.
A pair of spinal nerves exits from
each segment of the spinal cord.
Perception & Coordination

23. Perception & Coordination
Autonomic Nervous System

24. Perception & Coordination
Structure Sympathetic Stimulation Parasympathetic Stimulation
Iris (eye muscle)
Pupil Dilation
Near visionaccommodated
Pupil Constriction
Far visionaccommodated
SalivaryGlands Salivaproductionreduced Salivaproductionincreased
Oral/Nasal Mucosa Mucus productionreduced Mucus productionincreased
Heart Heart rate and force increased; coronaryvessels dilate
Heart rate and force decreased
Coronaryvessels constrict
Lung
Bronchial muscle relaxed
(bronchodilation)
Bronchial muscle contracted
(bronchoconstriction)
Stomach Peristalsisreduced Gastric juicesecreted; motilityincreased
Small Intestine Peristalsisreduced; inhibitedsecretion Digestionincreased, stimulatedperistalsis
Large Intestine Peristalsisreduced; inhibitedsecretion Secretions andmotilityincreased
Liver
Increasedconversionof
glycogento glucose( glycogenolysis& lipolysis )
Hepatic glycogenesis
Kidney Decreasedurinesecretion Increasedurine secretion
Adrenal medulla
Norepinephrine and
epinephrinesecreted
Bladder
Wall relaxed
Sphincter closed
Wall contracted
Sphincter relaxed/ open
Penis Ejaculation Erection

25. Accommodation – process by which
the eye adjusts viewing distances
of an object by changing the curvature
of its lens to focus a clear image on
the retina.
Photoreceptors: Rods & Cones
Rods – night vision l low light
Cones – bright lightl color visionP
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il Coordination
SENSORY ORGANS – VISION
THE EYE

26. SENSORY ORGANS – AUDITION
THE EAR
Pass vibz to the cochlea – organ of Corti
Then hair cells in the cochlea contact the
Tectorial membrane to generate impulses to
Auditory nerve to the brain
= hearing is perceived
Perception & Coordination
Sound waves Tympanic
Membrane
= Vibration of ossicles

27. SENSORY ORGANS – OLFACTION
The Olfactory System
Hair cells are the receptors in the olfactory epithelium
that respond to particular chemicals. These cells have
small hairs called cilia on one side and an axon on the
other side. In humans, there are about 40 million
olfactory receptors; in the German Shepherd dog, there
are about 2 billion olfactory receptors.
Perception & Coordination

28. SWEET SOUR SALTY BITTER
SENSORY ORGANS – GUSTATION
VII Facial
Greater Superficial Petrosal
X Vagal Nerve
Superior Larygeal
Soft
Palate
Epiglottis
IX Glossopharygeal
Lingual Tonsilar
VII Facial
Chorda Tympani
Anterior
third
■ Palatability is biologically important in determining appropriate food
selection. (most poisons are bitter)
For food to have a taste, it must be dissolved in water. There are four basic tastes:
sweet, salty, sour and bitter:

29. SENSORY ORGANS – TACTILE
Receptors Nerve Fiber Function / Location
A-beta Responds to hair displacement.
Wraps around hair follicle in, of
course, hairy skin.
Hair Follicle Ending
Ruffini Endings
Krause corpuscle
A-beta Responds to pressure on skin.
Dermis of both hairy and glabrous
skin.
A-beta Responds to pressure
Lips, tongue, and genitals.

30. SENSORY ORGANS – TACTILE
Receptors Nerve Fiber Function / Location
A-beta Responds to vibration. Most sensitive
Pacinian corpuscle
Meissner corpuscle
Merkel Cells
Free nerve endings
A-beta
A-delta and C
Deep layers of dermis in both hairy
and glabrous skin.
Responds to vibration.
Dermis of
glabrous skin.
Different types of free nerve endings
that respond to mechanical, thermal
or noxious stimulation.
Responds to pressure of the skin.
Epidermis of glabrous skin.

31. ASSESMENT
Health History
1. Family history–epilepsy ,glaucomalcataracts
2. History of problem
3. Headaches, Seizures
4. Medications
5. Recent change in behavior or
personality
6. Interview of sensory perceptions, deficits
and other problems
a. Visual – difficulty seeing near or far
objects, wearing of eye glasses or contact
lenses, visual disturbances
b. Auditory – difficulty hearing or changes in
hearing, wearing of hearing aids, can
determine location of sounds, distinguish
various voices, experience humming,
ringing, buzzing, crackling noises in ears
c. Gustatory – changes in ability to taste
d. Olfactory – changes in a
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32. ASSESMENT
Neurological exam
1. Cognitive function l Mental status
a. Intellectual function
b. Thought content
c. Emotions l Affect
d. Perception
e. Language ability
f. Body language l Posture
g. Orientation
h. Level of Consciousness
i. Attention Span
2. Cerebral function
a. Balance and coordination
3. Motor Function
a. Tone l size
b. Strength
c. Coordination
d. Posturing
4. Sensory function Perception & Coordination

33. NEUROLOGIC EXAM
1. Cognitive function l Mental status
a. Intellectual function
- Knowledge of current events
- Memory
- Calculation
- Use of judgment
- Attention span
b. Thought content
- spontaneous, natural, clear, relevant
coherent
- no fixed ideas, illusions, preoccupations
( ex. With death, morbid events,
hallucinations, paranoid ideations )
c. Emotions l Affect
- external manifestation of mood: angry
irritable, anxious, apathetic, euphoric
- normal mood fluctuation, unpredictable
mood swings from sadness to joy
- consistency in verbal & nonverbal cues
Perception & Coordination
d. Perception

34. NEUROLOGIC EXAM
1. Cognitive function l Mental status
e. Language ability
- can understand and communicate spoken &
written language
- answer questions appropriately
- can read a sentence and explain meaning
- Aphasia - deficiency in language function
Broca’s aphasia l non fluent aphasia
: choppy, broken words, short meaningful
phrases produced with great effort
: ex – Walk dog.
Wernicke’s aphasia l fluent aphasia
: speak fluently but with no meaning
: add unnecessary words; create new words
: ex – you know that smoodle pinkered & that I
want to get him round & take careof him like
you want before. = The dog needs to go
outside so I will take him for a walk
Global aphasia : with severe communication
difficulties and may be extremely limited in their
ability to speak or comprehend language
Anomia – problem with word finding. They know what
they want to say but cant fiP
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35. NEUROLOGIC EXAM
1. Cognitive function l Mental status
f. Body language
- Posture, gestures, movements
- Facial expression
g. Orientation
- To time, place and person
h. Level of Consciousness
1 conscious l alert
2 lethargic l somnolent l drowsy
3 obtunded
4 stuporous l light coma l semicoma
5 deep coma stimuli
- Glasgow coma scale
i. Attention Span
2. Cerebral function
a. Balance and coordination
- point to point testing
- assess speed, symmetry & degree of diff
- Romberg test Perception & Coordination

36. Extension 2
lowest sF
clo
ac
re
ci
,d3, is deep coma; a s1
core of 7 or below is
considered coma
Perception & Coordination
GLASGOW COMA SCALE
■ Eye opening
Spontaneous 4
To voice 3
To pain 2
None 1
■ Verbal responsiveness
Oriented 5
Confused conversation 4
Inappropriate words 3
Incomprehensible sounds 2
None 1
■ Motor responsiveness
Obeys commands 6
Localizes to pain 5
**TRAUMAFS
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drawal 4
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s client is a3
wake and oriented; the

37. NEUROLOGIC EXAM
3. Motor Function
a. Tone l size
- note atrophy, rigidity, spasticity
b. Strength
- flex or extend extremities against
resistance
c. Coordination
- tested by having patient to run
the heel down the anterior surface
of the tibia of the other leg
- Ataxia : incoodination of voluntary
muscle action
d. Posturing
Decorticate posture – corticospinal tract:
rigid flexion of arms, wrists and fingers
with adduction of upper extremities, &
extension with internal rotation of legs,
Decerebrate posture – midbrain & pons:
rigid extension of neck, back, arms &
Perception & Coordination
legs, with hyperpronation of arms

38. 2 4 5 – full range of motion against gravity &
1 5
1 5
2 5
resistance
4 – full range of motion against gravity &
moderate amount of resistance
3 – full range of motion against gravity
only
2 – full range of motion when gravityis
eliminated
1 – a weak muscle contraction when
muscle is palpated
0 – complete paralysis
Perception & Coordination

39. 4. sensory function
- superficial sensation
- superficial pain
- sensation to temperature & vibration
- vision: pupils, glasses, contact lenses
distortions:
halos around lights
difficulty in adjusting to dark room
diplopia
floaters
ptosis
anisocoria
nystagmus doll’s eye
- hearing: amount of hearing – aids, tinnitus
hearing loss
1. conductive hearing loss
( outer l middle ear )
sensory hearing loss l perceptive
loss ( inner ear )
5. reflexes
superficial
abdominal reflex
babinski (plantar) reflex
corneal (blin
P
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2.

40. ++
++
++
++
++ ++
++ ++
++
+ +
++
EYE EXAM
■ Pupils size and symmetry
■ Spontaneous eye movements
■ Pupillary reactions (direct & consensual)
■ Corneal reflex
■ Occulocephalic reflex
■ External eye and orbital exam
■ Fundus
G
cop
R
ic A
exaD
m ING OF REFLEXES
0 – No response
1 – Diminished (Hypoactive)
2 – Normal
3 – Increased
4 – Hyperactive ( hyperreflexia )

41. - Contrast medium or air injected into sub
arachnoid space
- Monitor VlS & Output. Encou
Pr
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nI& Coordination
DIAGNOSTIC EXAMS
1. X-rays of skull and spine- Used to detect atrophy, erosion or fractures
of bones; calcifications
2. Computerized Tomography Scan
- info obtained to construct a picture of the internal
structure of the brain; contrast medium may or
may not be used.
- obtain consent, check allergies, if with dye NPO 4
hours prior, assess for claustrophobia, explain
3. MRI-Magnetic Resonance Imaging
- 3D images, obtain consent & remove all metal
objects
4. Brain Scan
- Method: IV radioisotope to detect neoplasms,
brain abcess, subdural hemorrhage
- Obtain consent, explain procedure
5. MYELOGRAPHY

42. DIAGNOSTIC EXAMS
6. Cerebral Angiography
- Dye is injected to artery and vascular system
- Obtain consent, clear liquids before procedure
May have sedative, void before procedure, mark
distal pulses, warn client on feeling of warmth in
face during procedure
- Post: Monitor for LOC, hematoma, put ice cap to
site, extension of involved extremity, maintain
bed rest overnight, check peripheral pulses, color,
and temperature of extremeties
7. Encephalography-use of ultrasound to detect midline shift of
intracranial contents due to brain tumors, hematomas
8. Lumbar Puncture (LP)
- needle inserted between L4 – L5 to wldraw CSF
- obtain consent, empty bladder, in fetal position
- post: flat on bed, encourage OFI, check site for
bleeding, redness, swelling, clear drainage,
assess movement of extremeties
9. Electromyography (EMG) Perception & Coordination

43. DIAGNOSTIC EXAMS
10. Electroencephalography
- graphic recording of electrical activity of the brain - Used to detect
focus of seizure activity and to
quantitatively evaluate level of brain function
- Obtain consent, verify meds to be administered,
withhold caffeine or sedatives before EEG, no
styling gels or sprays on hair before EEG
- assist client in cleansing hair
11. Eye Exams
a. snellens test (eye chart)
Farsighted – Hyperopia
Nearsighted – Myopia
b. Ophtalmoscopic exam
c. Ocular tension test
12. Ear tests
a. otoscopic exam
b. whisper test
c. Weber test( bone conduction )
Perception & Coordination

44. DIAGNOSTIC EXAMS
The figures below show the human brain in the three
planes of section on "synthetic MR" images produced
Coronal Section Horizontal Section
Sagittal Section
Perception & Coordination

45. Perception & Coordination
Eye Safety
■ Your eyes are the windows to your
brain - Protect Them!
Here are some safety tips for caring for your eyes.
Walk, don't run, with sharp objects such as scissors, pens,
pencils and rulers
Avoid guns, bow-and-arrows, sling shots and firecrackers
Use good lighting to avoid tiring your eyes when reading, writing
or cruising the Internet
Learn basic first aid for your eyes in case an injury does
occur.
Tell your parents, school nurse or teachers if your eyes are
bothering you.

46. Perception & Coordination
Eye Safety
Wear proper eye protection whenyou are doing hazardous hobbies,
chores or mixing chemicals
Wear sunglasses that block both ultraviolet-A and ultraviolet-
B radiation from the sun
Never look directly at the sun
Point chemical sprays away from your faceBEFORE
spraying
Wear a helmet when biking, skateboarding or rollerskating
and wear your seatbelt in the car.

47. Perception & Coordination
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