Chapter 41

Neurological System

The capabilities of the human brain …

Hope you find it interesting Hope you find it interesting

The phenomenal power of the human mind

I cdnuolt blveiee taht I cluod aulaclty uesdnatnrd waht I was rdaniegThe phaonmneal pweor of the hmuan mnid! Aoccdrnig to a rscheearch at Cmabrigde Uinervtisy, it deosn't mttaer inwaht oredr the ltteers in a wrod are, the olny iprmoatnt tihng is taht the frist and lsat ltteer be in the rghit pclae. The rset can be a taotl mses and you can sitll raed it wouthit a porbelm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe. Amzanig huh? Yaeh, and I awlyas thought slpeling was ipmorantt.

NOTE: I read this somewhere and I just had to pass it around. I do not know the origins of the text

Take a look at the picture? What do you see?

Research has shown that young children cannot identify the intimate couple because they do not have prior memory associated with such a scenario.

Children see nine dolphins.

This is a test to determine if you already have a corrupted mind.  If it is hard for you to find the dolphins within six seconds, your mind is indeed corrupted.

Can you see a man's face and also a word?

Hint: Try tilting your head to the right, the word begins with 'L'

Can you see 10 faces in the tree…

Can you see a face here?

Can you see the outline of the ‘Unborn baby’?

Can you see the ‘Kissing Couple’?

Or the dangling legs? How about the stockings?

Can you see three women?

Can you tell the difference between a horse and a frog?

Watch closely...

Weird Walking Cow…

Warning: Do not view this while drinking.

More optical Illusions… is anything rotating?...

are these moving?...

how about these...

actually none of these move!

are all the hozontal lines parallel?...

are the purple lines straight or bent?

are the concentric lines, circles or a spiral?

Focus on the dot in the centre and move your head backwards and forwards...Weird...

Do you see gray areas in between the squares? Now where did they come from?  

This is quite amazing!• If you see this lady turning

clockwise, you are supposed to be using your right brain.

• If you see it turning the other way, (the lady turning counter-clockwise) you are supposed to be using your left brain.

• Some people can make the lady turn both ways, but most people see it turning only one way (It is said that only about 15% of the US population can see her (make her) move both ways)

 • BOTH DIRECTIONS CAN BE

DONE!See if you can make her go one way and then the other by shifting the brain's current!

This is without a doubt one of the coolest PC illusions I have seen so far…

Follow the instruction below. 1) Relax and stare at the 4 little dots on the middle of the picture for 30 seconds

2) then look at a blank wall near you (any smooth, single coloured surface)

3) a bright spot will appear 4) Blink your eyes a few times and you will see a figure emerging 5) What do you see? Moreover WHO do you see?

This is another example of an amazing illusion! If your brain works normally this is neat. If your eyes follow the movement of the rotating pink dot, the dots will remain only one color, pink. If you concentrate on the cross in the middle, after a while you will notice that this moving pink dot will turn green!

Keep looking at the cross a bit longer and you‘ll notice that all dots except the green one will disappear

It's amazing how our brain works – There really is no green dot, and the pink ones really don't disappear.

This should be proof enough; we don't always see what we think we see!

That’s all Folks…

Have a blessed and wonderful day – Have a blessed and wonderful day – Always!Always!

Anatomy and Physiology Review

• Nervous system divided into:– Central nervous system

• Brain and spinal cord

– Peripheral nervous system• Cranial nerves and spinal nerves

– Autonomic nervous system• Sympathetic and parasympathetic systems

Assessment

• Health history– Headaches– Clumsiness– Loss or change in function of extremity– Seizure activity– Numbness or tingling

(continued)

Assessment

• Health history– Change in vision– Pain– Extreme fatigue– Personality changes– Mood swings

(continued)

Assessment

• Cerebral function– Level of consciousness– Orientation– Mental status– Intellectual function– Emotional status– Pupil reaction– Communication

(continued)

Assessment

• Cranial nerve function

• Motor function– Muscle size and symmetry– Muscle tone– Muscle strength– Coordination– Balance– Posturing

(continued)

Assessment

• Sensory function– Tactile sensation– Pain and temperature– Vibration– Proprioception– Stereognosis– Graphesthesia– Integration of sensation

(continued)

Assessment

• Reflexes

Common Diagnostic Tests

• Lumbar puncture (LP)

• EEG

• EMG

• Imaging procedures

• Cerebral angiography

• Brain scan

• Myelogram

Epilepsy/Seizure Disorder

• Disorder of cerebral function

• Sudden attacks of altered consciousness, motor activity, or sensory phenomenon

• Primary method of controlling seizure activity:– Pharmacological

(continued)

Epilepsy/Seizure Disorder

• Goals:– Obtain seizure control with minimal side

effects and maintain safety

Types of Seizures

• Generalized– Tonic and/or clonic

• Grand mal

– Absence• Petit mal

– Myoclonic

(continued)

Types of Seizures

• Partial– Simple– Complex

Headache

• Pain in head caused by stimulation of pain-sensitive structures in cranium, head, or neck

• Primary– Tension, migraine, and cluster

• Secondary– Result of pathological condition

• Treat cause

Encephalitis and Meningitis

• Encephalitis– Inflammation of brain

• Meningitis– Inflammation of meninges

• Caused by virus, bacteria, fungi, or parasites

• Can cause cerebral edema, hemorrhage, and necrosis of brain tissue

(continued)

Encephalitis and Meningitis

• Symptoms vary depending on causative agent, area of involvement, and degree of damage to nerve tissue:– Fever, headache, nuchal rigidity,

photophobia, irritability, lethargy, and nausea/vomiting

• Treatment based on presenting symptoms

The Fight of Her Life

Head Injury

• Trauma to scalp, skull, or brain

• Complications:– Hemorrhage, cerebral edema, and

increased intracranial pressure

• Management focuses on early recognition, treatment of increasing intracranial pressure, and maintenance of normal body functions

Brain Tumor

• Space-occupying intracranial lesions– Either benign or malignant

• Symptoms differ according to area of lesion and rate of growth

• Management based on tumor type, growth rate, and assessment of client

(continued)

Brain Tumor

• Treatment:– Radiation, surgery, chemotherapy, and

medications

Guillain-Barré Syndrome

• Acute inflammatory process involving motor and sensory neurons of peripheral nervous system

• Demyelination begins in distal nerves and ascends symmetrically

• Remyelination occurs from proximal to distal

(continued)

Guillain-Barré Syndrome

• Symptoms:– Motor weakness and absence of reflexes,

respiratory failure, difficulty swallowing, autonomic dysfunctions, and pain

• Goal:– Prevent and treat complications

• E.g., immobility, infection, respiratory failure

Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease)

• Progressive, fatal disease

• Characterized by degeneration of motor neurons in cortex, medulla, and spinal cord

• No cure

(continued)

Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease)

• Treat symptoms and promote independence for as long as possible

• Treatment:– Medications, diet, and therapy

Multiple Sclerosis (MS)

• Chronic, progressive, degenerative disease of central nervous system

• Characterized by loss of myelin– Decreases nerve conduction

• Symptoms vary according to areas of demyelination– Sensory or motor

(continued)

MS

• Goals:– Limit exacerbations, prevent complications,

and maintain functional level

• Treatment:– Medications (e.g., interferon,

immunosuppressive drugs, etc.), well-balanced diet, physical or occupational therapy, and stress management

Parkinson’s Disease

• Chronic, progressive, degenerative disease• Affects area of brain controlling movement• Symptoms:

– Muscular rigidity, bradykinesia, resting tremors, muscular weakness, and loss of postural reflexes

• Treatment:– Drugs and physical or occupational therapy

Trigeminal Neuralgia (Tic Douloureux)

• Condition of cranial nerve V

• Characterized by abrupt paroxysms of pain and facial muscle contractions

• Treatment:– Drug therapy, nerve blocks, and surgery

Transient Ischemic Attack (TIA)

• Frequently precedes stroke

• Temporary impairment of blood flow to brain

• May last from few seconds to 24 hours

(continued)

TIA

• Symptoms:– Blurring of vision or blindness, loss of balance

or coordination, difficulty speaking or understanding, and weakness, numbness, or paralysis

Cerebrovascular Accident (CVA)

• Also known as brain attack or stroke

• Causes:– Ischemia from thrombus, embolus, severe

vasospasm, and cerebral hemorrhage

• Symptoms:– Neurological deficits of sensation, movement,

thought, memory, and speech

(continued)

CVA

• Loss of function, temporary or permanent

Medical-Surgical Management

• Airway maintenance and supportive therapy during first 24 to 48 hours

• Depending on location of CVA and extent of neurologic deficit, collaboration with physical, occupational, and speech therapists for client to reach optimal functional level of recovery

Herniated Intervertebral Disk

• Nucleus pulposus protrudes from vertebrae and may compress nerves of spinal cord

• Major cause of chronic back pain

• Symptoms:– Pain, motor changes, sensory changes, and

alterations in reflexes

(continued)

Herniated Intervertebral Disk

• Treatment:– Rest, stress reduction, immobility of spine,

physical therapy, transcutaneous electrical nerve stimulation (TENS), pain management, and surgery

Spinal Cord Injury

• From trauma to spinal cord or compression of spinal cord due to injury to supporting structures

• May be classified by:– Level of injury– Mechanism of injury– Neurological or functional level

(continued)

Spinal Cord Injury

• Extent of permanent injury cannot be determined immediately due to necrosis, edema, and spinal shock

• Medical management begins before client reaches hospital– Immobilization of head, neck, and vertebral

column

(continued)

Spinal Cord Injury

• Respiratory function continuously assessed

• Surgical interventions performed for decompression, realignment, and stabilization of vertebral column

• Interdisciplinary team works together to optimize client functional capabilities

Alzheimer’s Disease

• Progressive, degenerative neurological disease

• Brain cells destroyed

• Clients with advanced disease cannot be left alone

(continued)

Alzheimer’s Disease

• Respite care important for health of caregiver

• Treatment geared toward controlling undesirable symptoms and behaviors

Huntington’s Disease

• Chronic, progressive hereditary disease of nervous system

• Symptoms:– Chorea (abnormal, involuntary, purposeless

movements), difficulty chewing or swallowing, speech impairment, and bowel or bladder incontinence

(continued)

Huntington’s Disease

• Mental or intellectual impairment progresses to dementia

• Death usually results from heart failure, pneumonia, infection, or choking

• Must collaborate with social worker, chaplain, physician, and mental health worker

Gilles De La Tourette’s Syndrome

• Neurological movement disorder

• Prominent behavioral manifestations

• Symptoms:– Motor tics, involuntary repetitive movements

of mouth, face, head, or neck, involuntary swearing, echolalia, and involuntary repetition of person’s own speech

(continued)

Gilles De La Tourette’s Syndrome

• Treatment:– Medications, psychotherapy, family

counseling, and emotional support

Chapter 60

Infants with Special Needs:Birth to 12 Months

Spina Bifida

• Neural tube defect– Incomplete closure of vertebrae and neural

tube results in opening through which meninges and spinal cord may protrude

• Surgery required to close defect

Hydrocephalus

• Results when balance between rate of cerebrospinal fluid formation and absorption disturbed

• Symptoms:– Abnormally large head at birth, bulging

anterior fontanels, and eyes that appear to be pushed downward

• Requires surgical insertion of shunt

Febrile Convulsions

• Involuntary muscle contraction and relaxation

• Usually occur early in course of high fever and carry little risk of neurological damage

• Treatment:– Antipyretics and teaching

Meningitis

• Three main types:– Bacterial– Tubercular– Viral

• Symptoms sudden or gradual:– High-pitched cry, fever, seizures, irritability,

vomiting, bulging fontanel, and poor feeding

(continued)

Meningitis

• Treatment:– Spinal tap, isolation, and medications

Cerebral Palsy

• Results from damage to motor centers of brain before, during, or after birth

• Nonprogressive

• Symptoms vary in severity:– Motor disorders, seizures, impaired vision,

and difficulty swallowing and speaking

(continued)

Cerebral Palsy

• Multidisciplinary team treatment to assist child in developing maximum potential