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The Human Nociceptive Withdrawal Reflex The Human Nociceptive Withdrawal Reflex Improved Understanding and Optimization of Reflex Elicitation and Recording PhD Thesis by Ken Steffen Frahm Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Denmark ISBN 978-87-92982-69-8 (paperback) ISBN 978-87-92982-68-1 (e-book) Published, sold and distributed by: River Publishers Niels Jernes Vej 10 9220 Aalborg Ø Denmark Tel.: +45369953197 www.riverpublishers.com Copyright for this work belongs to the author, River Publishers have the sole right to distribute this work commercially. All rights reserved c 2013 Ken Steffen Frahm. No part of this work may be reproduced, stored in a retrieval system, or trans- mitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording or otherwise, without prior written permission from the Publisher. Contents Preface vii Acknowledgements ix English summary xi Danish summary xiii List of abbreviations xv Introduction 1 1.1 The Nociceptive Withdrawal Reflex ......................................... 2 Aims 7 2.1 Overview of study aims ............................................................. 9 2.2 Papers ...................................................................................... 10 Methods 11 3.1 Reflex monitoring (study I) ..................................................... 11 3.2 Noxious stimulation (study I & II) .......................................... 15 3.3 Mapping the neural activation in the sole of the foot (study -
Focusing on the Re-Emergence of Primitive Reflexes Following Acquired Brain Injuries
33 Focusing on The Re-Emergence of Primitive Reflexes Following Acquired Brain Injuries Resiliency Through Reconnections - Reflex Integration Following Brain Injury Alex Andrich, OD, FCOVD Scottsdale, Arizona Patti Andrich, MA, OTR/L, COVT, CINPP September 19, 2019 Alex Andrich, OD, FCOVD Patti Andrich, MA, OTR/L, COVT, CINPP © 2019 Sensory Focus No Pictures or Videos of Patients The contents of this presentation are the property of Sensory Focus / The VISION Development Team and may not be reproduced or shared in any format without express written permission. Disclosure: BINOVI The patients shown today have given us permission to use their pictures and videos for educational purposes only. They would not want their images/videos distributed or shared. We are not receiving any financial compensation for mentioning any other device, equipment, or services that are mentioned during this presentation. Objectives – Advanced Course Objectives Detail what primitive reflexes (PR) are Learn how to effectively screen for the presence of PRs Why they re-emerge following a brain injury Learn how to reintegrate these reflexes to improve patient How they affect sensory-motor integration outcomes How integration techniques can be used in the treatment Current research regarding PR integration and brain of brain injuries injuries will be highlighted Cases will be presented Pioneers to Present Day Leaders Getting Back to Life After Brain Injury (BI) Descartes (1596-1650) What is Vision? Neuro-Optometric Testing Vision writes spatial equations -
Central Nervous System
MCQ : Central Nervous System Section 1 General Functional Organization of the Nervous System 1 ) The central nervous system includes all the following components, except :- a- spinal cord b- medulla oblongata c- autonomic ganglia d- diencephalon 2 ) The central nervous system is connected with the peripheral nervous system by all the following types of nerve fibers, except :- a- postganglionic autonomic fibers b- preganglionic autonomic fibers c- somatic motor fibers d- autonomic sensory fibers 3 ) The sensory system is involved in all the following, except :- a- initiation of reflex movements b- initiation of voluntary movements c- learning processes d- initiation of emotional responses 1 MCQ : Central Nervous System Section 2 Sensory System and Sensory Receptors 1) The two-element sensory receptors differ from other types of receptors in being:- a- more numerous b- more widely spread in the body c- more sensitive d- composed of specialized cells at the sensory nerve terminals 2) Sensory receptors are classified functionally according to the following criteria, except :- a- their location in the body b- the nature of tissues in which they are found c- the nature of stimuli acting on them d- their connection with cerebral coretx 3) Most sensory receptors :- a- are stimulated by different types of stimuli b- are stimulated only by specific stimuli c- posses a high threshold for their specific stimuli d- only ‘b’ and ‘c’ are correct 4) A specific stimulus produces a receptor potential by :- a- inhibiting Na + influx into receptor b- inhibiting -
VTPP 423 Syllabus General
VTPP 423 BIOMEDICAL PHYSIOLOGY I COURSE INFORMATION Description: Biomedical Physiology I. (3-2). Credit 4. Physiological principles, review of cellular physiology, and development of an understanding of the nervous system and muscle, cardiovascular, and respiratory physiology; clinical applications related to organ systems. Prerequisites: VIBS 305; junior or senior classification. Discussions: MWF: 9:10 a.m. – 10:00 a.m. (Room 309, VICI) Lab Sessions: 501: Tuesdays : 12:40 - 2:30 p.m. (Room 320, VICI) 504: Fridays : 12:40 - 2:30 p.m. (Room 320, VICI) Instructor: J.D. Herman Office Hours: MWF 10:00 – 11:00 or by appointment Office Room # 316 VIDI Phone: 979/862-7765 [email protected] Teaching TBA Assistant: Required Lauralee Sherwood: Human Physiology: from cells to systems, 8th edition, Brooks/Cole Cengage Resources: Learning, ISBN: 978-1-111-57743-8 iClicker 2 Web-sites: htt p://ecampus.tamu.edu/ Course Goal: To understand the physiological significance of cells, organs and organ systems in maintaining homeostasis of the mammalian organism. (To develop critical thinking, problem solving and self- learning skills in preparation for a career in medicine/science.) Learning Outcomes: By the end of the course, the student will: • investigate and solve mathematical calculations commonly used in physiology • articulate an understanding of homeostatic control mechanisms of the: ▪ central nervous system ▪ muscular system ▪ cardiovascular system ▪ respiratory system ▪ renal system • collect and analyze physiologic data related to the ▪ central nervous system ▪ muscular system ▪ cardiovascular system ▪ respiratory system ▪ renal system • evaluate the relationship between physiology and disease ▪ including insight into critical thinking in the clinical setting ▪ including goals and mechanisms of some pharmacologic agents Course Grading: A total of 400 points are possible in the course. -
Retained Neonatal Reflexes | the Chiropractic Office of Dr
Retained Neonatal Reflexes | The Chiropractic Office of Dr. Bob Apol 12/24/16, 1:56 PM Temper tantrums Hypersensitive to touch, sound, change in visual field Moro Reflex The Moro Reflex is present at 9-12 weeks after conception and is normally fully developed at birth. It is the baby’s “danger signal”. The baby is ill-equipped to determine whether a signal is threatening or not, and will undergo instantaneous arousal. This may be due to sudden unexpected occurrences such as change in head position, noise, sudden movement or change of light or even pain or temperature change. This activates the stress response system of “fight or flight”. If the Moro Reflex is present after 6 months of age, the following signs may be present: Reaction to foods Poor regulation of blood sugar Fatigues easily, if adrenalin stores have been depleted Anxiety Mood swings, tense muscles and tone, inability to accept criticism Hyperactivity Low self-esteem and insecurity Juvenile Suck Reflex This is active together with the “Rooting Reflex” which allows the baby to feed and suck. If this reflex is not sufficiently integrated, the baby will continue to thrust their tongue forward, pushing on the upper jaw and causing an overbite. This by nature affects the jaw and bite position. This may affect: Chewing Difficulties with solid foods Dribbling Rooting Reflex Light touch around the mouth and cheek causes the baby’s head to turn to the stimulation, the mouth to open and tongue extended in preparation for feeding. It is present from birth usually to 4 months. -
The Corneomandibular Reflex1
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.34.3.236 on 1 June 1971. Downloaded from J. Neurol. Neurosurg. Psychiat., 1971, 34, 236-242 The corneomandibular reflex1 ROBERT M. GORDON2 AND MORRIS B. BENDER From the Department of Neurology, the Mount Sinai Hospital, New York, U.S.A. SUMMARY Seven patients are presented in whom a prominent corneomandibular reflex was observed. These patients all had severe cerebral and/or brain-stem disease with altered states of consciousness. Two additional patients with less prominent and inconstant corneomandibular reflexes were seen; one had bulbar amyotrophic lateral sclerosis and one had no evidence of brain disease. The corneomandibular reflex, when found to be prominent, reflects an exaggeration of the normal. Therefore one may consider the corneomandibular hyper-reflexia as possibly due to disease of the corticobulbar system. The corneomandibular reflex consists of an involun- weak bilateral response on a few occasions. This tary contralateral deviation and protrusion of the was a woman with bulbar and spinal amyotrophic lower jaw during corneal stimulation. It is not a lateral sclerosis. The other seven patients hadProtected by copyright. common phenomenon and has been rediscovered prominent and consistently elicited corneo- several times since its initial description by Von mandibular reflexes. The clinical features common to Solder in 1902. It is found mostly in patients with these patients were (1) the presence of bilateral brain-stem or bilateral cerebral lesions who are in corneomandibular reflexes, in some cases more coma or semicomatose. prominent on one side; (2) a depressed state of con- There have been differing opinions as to the sciousness, usually coma; and (3) the presence of incidence, anatomical basis, and clinical significance severe neurological abnormalities, usually motor, of this reflex. -
What's the Connection?
WHAT’S THE CONNECTION? Sharon Winter Lake Washington High School Directions for Teachers 12033 NE 80th Street Kirkland, WA 98033 SYNOPSIS Students elicit and observe reflex responses and distinguish between types STUDENT PRIOR KNOWL- of reflexes. They then design and conduct experiments to learn more about EDGE reflexes and their control by the nervous system. Before participating in this LEVEL activity students should be able to: Exploration, Concept/Term Introduction Phases ■ Describe the parts of a Application Phase neuron and explain their functions. ■ Distinguish between sensory and motor neurons. Getting Ready ■ Describe briefly the See sidebars for additional information regarding preparation of this lab. organization of the nervous system. Directions for Setting Up the Lab General: INTEGRATION Into the Biology Curriculum ■ Make an “X” on the chalkboard for the teacher-led introduction. ■ Health ■ Photocopy the Directions for Students pages. ■ Biology I, II ■ Human Anatomy and Teacher Background Physiology A reflex is an involuntary neural response to a specific sensory stimulus ■ AP Biology that threatens the survival or homeostatic state of an organism. Reflexes Across the Curriculum exist in the most primitive of species, usually with a protective function for ■ Mathematics animals when they encounter external and internal stimuli. A primitive ■ Physics ■ example of this protective reflex is the gill withdrawal reflex of the sea slug Psychology Aplysia. In humans and other vertebrates, protective reflexes have been OBJECTIVES maintained and expanded in number. Examples are the gag reflex that At the end of this activity, occurs when objects touch the sides students will be able to: or the back of the throat, and the carotid sinus reflex that restores blood ■ Identify common reflexes pressure to normal when baroreceptors detect an increase in blood pressure. -
The Leg Cross Flexion-Extension Reflex: Biomechanics, Neurophysiology, MNRI® Assessment, and Repatterning
Po R t a l t o n e u R o d e ve l o P m e n t a n d le a R n i n g t h e o R y a n d h i s t o R y o f m n R i ® R e f l e x i n t e g R a t i o n The Leg Cross Flexion-Extension Reflex: Biomechanics, Neurophysiology, MNRI® Assessment, and Repatterning Elvin Akhmatov, MA, Ph.D. Student, Orlando, FL, USA; Jakub Buraczewski, PT, MNRI® Core Specialist; Denis Masgutov, Director of SMEI , Poland Introduction wo separate reflexes, Phillipson’s Withdrawal and Leg Cross Flexion-Extension, are eas- ily confused because they have similar motor Tpatterns and are elicited by stimuli that can appear to be alike and usually manifest at the same time. The authors’ purpose is to distinguish clearly between these two reflexes and to present detailed information on the one they refer to as the Leg Cross Flexion-Extension Reflex. The other reflex, often con- Elvin Akhmatov Jakub Buraczewski Denis Masgutov fused with Leg Cross Flexion-Extension, goes by sev- eral names: Phillipson’s Withdrawal, Phillipson’s Leg Flexion, Crossed Extensor, and Leg Withdrawal Reflex, among others. For clarity in this paper, the other reflex will be referred to as Phillipson’s Withdrawal. On the neurophysiological level, these two reflex patterns present the work of two different nerve tracts – tactile and proprioceptive, activated and processed by different receptors. The Leg Cross Flexion-Extension Reflex is extremely important for overall sensory-motor integration, mo- tor programing and control. -
Normal Plantar Response: Integration of Flexor and Extensor Reflex Components
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.26.1.39 on 1 February 1963. Downloaded from J. Neurol. Neurosurg. Psychiat., 1963, 26, 39 Normal plantar response: integration of flexor and extensor reflex components LENNART GRIMBY From the Department of Neurology, Karolinska Institute, Serafimerlasarettet, Stockholm, Sweden The reflexes elicited by painful stimulation of the the suprasegmental control of the reflex centres, the plantar surface of the foot have been studied receptive field of the reflex is limited to the skin area extensively for a long time and the relation between where it is adequate for protective purposes, viz., the reflexes obtained in normal and in pathological the ball of the great toe. cases has been the subject of considerable debate. An Previous investigations (Eklund et al., 1959; excellent survey of previous investigations is to be Kugelberg et al., 1960) have shown that the main found in the review by Walshe (1956). As in most difference between the electromyographic pattern of studies of human reflexes, the technique commonly a flexor plantar response and that of an extensor used has, however, not permitted an exact deter- plantar response is that the reflex plantar flexion of mination of the latency values of the reflexes, and the great toe is associated with activity in the short it has thus not been possible to judge with certainty hallux flexor and reciprocal inhibition of the guest. Protected by copyright. to what extent the movements studied have been voluntary activity in the short hallux extensor, purely spinal and to what extent of cerebral origin. whereas, conversely, reflex dorsiflexion of the great By means of brief electric stimuli and an electro- toe is accompanied by activity in the short hallux myographic recording technique these latency values extensor and reciprocal inhibition of the voluntary can, however, be exactly determined, and in this way activity in the short hallux flexor. -
Neurologic Assessment Skills for the Acute Medical Surgical Nurse
on230103.qxd 1/20/2004 12:01 PM Page 3 Neurologic Assessment Skills for the Acute Medical Surgical Nurse Janet T. Crimlisk ▼ Margaret M. Grande Practical and efficient neurologic assessment skills are vital for when neurologic conditions are changing and what acute care nurses. During an acute neurologic event, the should be the nurse’s immediate response? nurse needs a focused assessment of the pertinent history and symptom analysis and an immediate head-to-toe survey, Review of Central Nervous System eliciting any abnormal signs to identify and correctly report the medical problem. When a patient requires routine moni- To identify appropriate assessment information and toring of neurologic signs, the nurse’s role includes a neuro- apply these skills, a brief overview of the central nervous system (CNS) is presented. The CNS consists of the brain, logic assessment, collecting and assimilating that data, inter- which comprises the cerebrum, cerebellum, and brain- preting the patient problem, notifying the physician when stem (see Figure 1). The brain consists of two central appropriate, and documenting that data. This article presents hemispheres, right and left, which form the largest part of an overview of a staff nurse’s neurologic assessment, explains the brain. There are four main lobes: frontal (Broca’s common neurologic tests performed at the bedside, identifies area, judgment, insight, problem solving, and emotion), an efficient way to perform the assessment, and indicates temporal (auditory, comprehension, speech, and taste), what to include and document when “neuro signs” are parietal (sensory and proprioception), and occipital ordered. (vision). In the central part of the cerebrum is the dien- KEY WORDS: Neurologic assessment, Education, Medical surgi- cephalon, which surrounds the third ventricle and forms cal nurse the central core and contains the thalamus and the hypo- thalamus (the autonomic nervous system regulator). -
The Nervous System Reflexes Spinal Reflexes Reflex Arc the Stretch
1/17/2016 Reflexes • Rapid, involuntary, predictable motor response to a stimulus The Nervous System Spinal Reflexes Spinal Reflexes Reflex Arc • Spinal somatic reflexes • Components of a reflex arc – Integration center is in the spinal cord 1. Receptor—site of stimulus action – Effectors are skeletal muscle 2. Sensory neuron—transmits afferent impulses to the CNS • Testing of somatic reflexes is important clinically 3. Synapses in gray matter—either monosynaptic or to assess the condition of the nervous system polysynaptic region within the CNS 4. Motor neuron—conducts efferent impulses away from cord • Identical stimulus should always elicit the same 5. Effector—muscle fiber or gland cell that responds to response stereotyped reflex the efferent impulses by contracting or secreting Stimulus The Stretch Reflex Skin • Monosynaptic reflex – 2 neurons (sensory and motor), 1 synapse 1 Receptor Interneuron • Muscle spindles 2 Sensory neuron – Sensory receptors in belly of muscle 3 Integration center – Detects changes in length of muscle 4 Motor neuron • Muscle is stretched, reflex reverses the stretch 5 Effector • Important for coordination, maintenance of posture, keeps muscles from over stretching Spinal cord (in cross section) Figure 13.14 1 1/17/2016 Secondary sensory The patellar (knee-jerk) reflex—a specific example of a stretch reflex Efferent (motor) endings (type II fiber – fiber to muscle spindle senses when muscle 2 is still) Quadriceps 3a (extensors) 3b 3b ααα Efferent (motor) 1 Primary sensory fiber to extrafusal Patella endings (type Ia Muscle Spinal cord muscle fibers spindle Fiber – senses (L 2–L4) stretching) Extrafusal muscle 1 Tapping the patellar ligament excites fiber Hamstrings Patellar muscle spindles in the quadriceps. -
Overshunting-Associated Myelopathy: Report of 2 Cases
NEUROSURGICAL FOCUS Neurosurg Focus 41 (3):E16, 2016 Overshunting-associated myelopathy: report of 2 cases Jason Man-kit Ho, MBChB, Hing-Yuen Law, FRCS(SN), Shing-Chau Yuen, FRCS, and Kwong-Yui Yam, FRCS Department of Neurosurgery, Tuen Mun Hospital, Tuen Mun, Hong Kong Special Administrative Region, China The authors present 2 cases of cervical myelopathy produced by engorged vertebral veins due to overshunting. Over shuntingassociated myelopathy is a rare complication of CSF shunting. Coexisting cervical degenerative disc disease may further increase the difficulty of diagnosing the condition. Neurosurgeons and others who routinely evaluate patients with intracranial shunts should be familiar with this rare but possible diagnosis. http://thejns.org/doi/abs/10.3171/2016.7.FOCUS16179 KEY WOrdS overshunting; myelopathy; hydrocephalus; ventriculoperitoneal shunt VERSHUNTING-ASSOCIATED myelopathy is a rare com- temperature sensation were impaired on the right palm. plication of CSF shunting.4 Few case reports have The patient had an upgoing plantar reflex and ankle clonus been published over the years. Here we add 2 cas- bilaterally. Tandem walking could barely be performed. esO to the literature. T1-weighted Gd-enhanced MRI of the brain and cervi- cal spine revealed diffuse pachymeningeal enhancement Case Reports (Fig. 1 upper) and engorgement of vertebral veins from Case 1 the C-1 to the C-3 level causing cord compression at the History and Presentation corresponding levels (Fig. 2A and B). T2-weighted imag- ing showed signal hyperintensity in the spinal cord (Fig. 3 This 64-year-old woman had undergone ventriculoperi- left) at the C-1 level. Degenerative changes (marginal os- toneal (VP) shunt placement for treatment of hydrocepha- teophytes and disc bulging) were noted at the C5–6 and lus after clipping of a ruptured posterior communicating C6–7 levels, with indentation of the anterior thecal sac.