Additional Information
Book Details
Abstract
Boost your skills in planning and managing physical rehabilitation! Neuroscience: Fundamentals for Rehabilitation, 5th Edition provides a practical guide to the nervous system and how it affects the practice of physical and occupational therapy. Case studies and first-person stories from people with neurologic disorders make it easier to apply your knowledge to the clinical setting. New to this edition are new chapters on neuroanatomy imaging and neurologic examination techniques. Written by noted PT educator Laurie Lundy-Ekman, this book uses evidence-based research to help you understand neurologic disorders and treat clients who have physical limitations due to nervous system damage or disease.
- Logical, systems approach to neuroscience makes it easier to master complex information and provides a framework for conducting a neurologic examination and evaluation.
- A clinical perspective of neuroscience is provided through case studies, personal stories written by patients, and summaries of key features of neurologic disorders and the body systems they affect.
- Five sections — Overview of Neurology, Neuroscience at the Cellular Level, Development of the Nervous System, Vertical Systems, and Regions — first show how neural cells operate, and then allow you to apply your knowledge of neuroscience.
- Emphasis on topics critical to physical rehabilitation includes coverage of abnormal muscle tone, chronic pain, control of movement, and differential diagnosis of dizziness.
- Hundreds of color-coded illustrations show body structures and functions across systems.
- Clinical Notes case studies demonstrate how neuroscience knowledge may be applied to clinical situations.
- Pathology boxes provide a quick summary of the features of neurologic disorders commonly encountered in rehabilitation practice.
- New! Neuroimaging and Neuroanatomy Atlas chapter includes MRI and CT images.
- NEW! Neurologic Disorders and the Neurologic Examination chapter provides detailed descriptions and photographs of techniques.
- NEW! Diagnostic Clinical Reasoning boxes help you develop the ability to recognize patterns of signs and symptoms associated with specific diagnoses.
- NEW! Updated content reflects the most current research findings.
- NEW! Reader-friendly approach converts long, technical chapters into smaller, more accessible chapters.
- NEW! Reorganized chapters progress from the cellular view to the systems view to the regional view.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Neuroscience | i | ||
| Copyright Page | ii | ||
| Contributors | iii | ||
| Preface | iv | ||
| Distinctive Features of This Text Include | iv | ||
| Learning Aids | iv | ||
| Acknowledgments | v | ||
| Table Of Contents | vi | ||
| 1 Introduction to Neuroscience | 1 | ||
| Chapter Outline | 1 | ||
| Analysis of the Nervous System | 1 | ||
| What Do We Learn From These Studies? | 1 | ||
| Organization of This Book | 1 | ||
| Diagnostic Clinical Reasoning | 3 | ||
| Reference | 3.e1 | ||
| 1 Overview of Neurology | 4 | ||
| 2 Neuroanatomy | 4 | ||
| Chapter Outline | 4 | ||
| Chapter Objectives | 4 | ||
| Introduction to Neuroanatomy | 4 | ||
| Introduction to the Atlas | 4 | ||
| Cellular-Level Neuroanatomy | 4 | ||
| Peripheral Nervous System | 6 | ||
| Central Nervous System | 6 | ||
| Spinal Region | 6 | ||
| Brainstem and Cerebellar Region | 6 | ||
| Cranial Nerves | 7 | ||
| Cerebellum | 7 | ||
| Cerebrum | 7 | ||
| Diencephalon | 7 | ||
| Cerebral Hemispheres | 7 | ||
| Cerebrospinal Fluid System: Ventricles and Meninges | 9 | ||
| Blood Supply | 9 | ||
| Blood Supply to the Brainstem and Cerebellum | 9 | ||
| Blood Supply to Cerebral Hemispheres | 9 | ||
| Circle of Willis | 9 | ||
| Cerebral Arteries | 9 | ||
| Summary | 10 | ||
| Atlas | 14 | ||
| 3 Neurologic Disorders and the Neurologic Examination | 44 | ||
| Chapter Outline | 44 | ||
| Chapter Objectives | 44 | ||
| Clinical Application of Learning Neuroscience | 46 | ||
| Neurologic Disorders | 46 | ||
| Incidence and Prevalence of Neurologic Disorders | 46 | ||
| Neurologic Examination | 47 | ||
| History | 47 | ||
| Tests and Measures | 48 | ||
| Diagnosis | 48 | ||
| Neurologic Screening Examination | 48 | ||
| Comprehensive Neurologic Examination | 48 | ||
| Special Tests | 50 | ||
| TESTS of Neurologic Function | 50 | ||
| Mental Status Testing | 50 | ||
| Consciousness Level | 50 | ||
| Attention: World Test or Digit Span Test (Screening Test) | 51 | ||
| Language and Speech | 51 | ||
| Comprehension | 51 | ||
| Naming | 51 | ||
| One-Minute Category Naming Test | 51 | ||
| Reading | 51 | ||
| Writing | 51 | ||
| Orientation | 51 | ||
| Declarative Memory (Memory of Facts and Events; Screening Test) | 51 | ||
| Working Memory | 51 | ||
| Recent Memory | 52 | ||
| Long-Term Memory | 52 | ||
| Goal-Directed Behavior (Also Known as Executive Function; Screening Test) | 52 | ||
| One-Minute Naming Test: Initial Letter | 52 | ||
| Calculation | 52 | ||
| Stereognosis (Special Test) | 52 | ||
| Visual Identification (Special Test) | 52 | ||
| Bilateral Simultaneous Stimulation (Special Test) | 52 | ||
| Touch | 52 | ||
| Vision | 52 | ||
| Motor Planning | 53 | ||
| Comprehension of Spatial Relationships (Special Tests) | 53 | ||
| Activities of Daily Living | 53 | ||
| Drawing | 53 | ||
| Visual Scanning | 53 | ||
| Body Scheme Drawing | 54 | ||
| Concept of Relationship of Body Parts | 54 | ||
| Orientation to Vertical Position | 54 | ||
| Cranial Nerve Observation and Testing | 54 | ||
| Olfactory Nerve (Cranial Nerve 1) (Special Test) | 54 | ||
| Optic Nerve (Cranial Nerve 2) | 54 | ||
| Visual Fields (Screening Test) | 54 | ||
| Cranial Nerves 2 and 3: Pupillary Light Reflex (Screening Test) | 54 | ||
| Oculomotor Nerve (Cranial Nerve 3) | 55 | ||
| Upper Eyelid Position and Raising the Upper Eyelid (Screening Test) | 55 | ||
| Pupillary Responses | 55 | ||
| Observe Size of Pupils in Room Light | 55 | ||
| Pupillary Response to Light | 55 | ||
| Pupillary Response to Near and Far Objects | 55 | ||
| Convergence | 55 | ||
| Gaze Stability and Extraocular Movements (Cranial Nerves 3, 4, and 6) | 55 | ||
| Forward Gaze (Screening Test) | 56 | ||
| Eye Alignment (Special Tests) | 57 | ||
| Cover Test | 57 | ||
| Cover-Uncover and Alternate Cover Tests | 58 | ||
| Smooth Pursuit Eye Movements (Screening Test) | 58 | ||
| Oculomotor Nerve (Cranial Nerve 3) Smooth Pursuits | 59 | ||
| Trochlear Nerve (Cranial Nerve 4) Smooth Pursuits | 59 | ||
| Abducens Nerve (Cranial Nerve 6) Smooth Pursuits | 59 | ||
| Differential Diagnosis: Cranial Nerve 3, 4, or 6 Lesions Versus Supranuclear or Medial Longitudinal Fasciculus Lesions | 59 | ||
| Tests for Oculomotor Centers and Pathways That Control Eye Movements | 59 | ||
| Voluntary Saccades | 59 | ||
| Optokinetic Nystagmus (Special Test) | 60 | ||
| Dynamic Visual Acuity (Special Test) | 60 | ||
| Nystagmus | 61 | ||
| Physiologic Nystagmus | 61 | ||
| Pathologic Nystagmus (Special Tests) | 61 | ||
| Spontaneous Nystagmus, Eyes Open. | 61 | ||
| Nystagmus, Eyes Closed. | 61 | ||
| Eccentric Gaze Holding Nystagmus. | 61 | ||
| Trigeminal Nerve (Cranial Nerve 5) | 61 | ||
| Light Touch Testing (Screening Test) | 61 | ||
| Sharp Versus Dull Sensation: Pinprick | 62 | ||
| Corneal Reflex | 62 | ||
| Jaw Deviation and Jaw Closing | 62 | ||
| Jaw Jerk Reflex (Not Recommended) | 62 | ||
| Facial Nerve (Cranial Nerve 7) (Screening Test) | 62 | ||
| Vestibulocochlear Nerve (Cranial Nerve 8) | 63 | ||
| Hearing Tests That Examine the Cochlear Branch of Cranial Nerve 8 | 63 | ||
| Hearing Screening Using Finger Rub (Screening Test) | 63 | ||
| Rinne Test (Special Test) | 63 | ||
| Weber Test (Special Test) | 63 | ||
| Vestibular Branch | 63 | ||
| Past Pointing Test (Screening Test) | 63 | ||
| Head Impulse Test: Vestibulo-Ocular Reflex (Special Test) | 65 | ||
| Tests to Determine Causes of Dizziness | 65 | ||
| Head Position Nystagmus Test for Paroxysmal Positional Vertigo: Dix-Hallpike Maneuver (Special Test) | 65 | ||
| Supine Roll to Side Test (Special Test) | 66 | ||
| Oculomotor Control: HINTS Examination: Head-Impulse—Nystagmus—Test-of-Skew (Special Test) | 66 | ||
| Glossopharyngeal Nerve (Cranial Nerve 9) | 67 | ||
| Vagus Nerve (Cranial Nerve 10) | 67 | ||
| Accessory Nerve (Cranial Nerve 11) | 67 | ||
| Hypoglossal Nerve (Cranial Nerve 12) | 67 | ||
| Tongue Protrusion (Screening Test) | 67 | ||
| Manual Resistance of Tongue Movement | 67 | ||
| Autonomic Testing | 68 | ||
| Orthostatic Hypotension Test (Screening Test) | 68 | ||
| Observe the Appearance of the Skin (Screening Test) | 68 | ||
| Bladder, Bowel, and Sexual Functions | 68 | ||
| Motor Testing | 68 | ||
| Muscle Power | 68 | ||
| Quick Muscle Power Tests (Screening Test) | 68 | ||
| Manual Muscle Test | 69 | ||
| Pronator Drift (Special Test) | 69 | ||
| Muscle Bulk (Visual Inspection Is a Screening Test) | 69 | ||
| Muscle Tone: Muscle Resistance to Passive Stretch (Screening Test) | 69 | ||
| Ashworth Scale for Measuring Spasticity and Modified Ashworth Scale (Not Recommended) | 69 | ||
| Somatosensory Testing | 69 | ||
| Quick Somatosensory Testing (Screening Test) | 71 | ||
| Light Touch: Primary Sensation | 71 | ||
| Location Test for Light Touch | 71 | ||
| Ipswich Touch Test (Special Test) | 71 | ||
| Tactile Thresholds Test for Light Touch (Special Test) | 72 | ||
| Light Touch: Cortical Sensations (Special Tests) | 72 | ||
| Two-Point Discrimination | 72 | ||
| Bilateral Simultaneous Touch: Test for Sensory Extinction | 73 | ||
| Graphesthesia | 73 | ||
| Conscious Proprioception | 73 | ||
| Joint Movement | 73 | ||
| Joint Position | 73 | ||
| Vibration | 74 | ||
| Sharp Versus Dull Sensation: Pinprick Sensation (Screening Test) | 74 | ||
| Sharp, Prickling Sensation | 74 | ||
| Discriminative Temperature Sensation (Special Test) | 74 | ||
| Brush Allodynia Test for Neuropathic Pain (Special Test) | 74 | ||
| Coordination Testing | 75 | ||
| Rapid Alternating Movements (Screening Test) | 75 | ||
| Accuracy and Smoothness of Movements | 75 | ||
| Finger-to-Nose Test (Screening Test) | 75 | ||
| Finger-to-Finger Test | 75 | ||
| Heel-to-Shin Test (Screening Test) | 75 | ||
| Tandem Walking: Walking Heel-to-Toe | 77 | ||
| Spinal Reflex Testing | 77 | ||
| Tendon Reflex (Screening Test) | 77 | ||
| Clonus (Special Test) | 77 | ||
| Plantar Reflex (Screening Test) | 78 | ||
| Postural Control Testing | 79 | ||
| Romberg Test | 79 | ||
| Tandem Romberg (Screening Test) | 79 | ||
| Stability: Abnormal Involuntary Movements (Observation Is a Screening Test) | 79 | ||
| Gait | 79 | ||
| Walking | 79 | ||
| Tandem Walking: Walking Heel-to-Toe | 79 | ||
| Walking on Heels (Screening Test) | 80 | ||
| Walking on Toes (Screening Test) | 80 | ||
| Stops Walking When Talking | 80 | ||
| Walking While Turning the Head Right and Left on Command or While Moving the Head Up and Down (Screening Test) | 81 | ||
| Stopping Quickly on Command, Making a Quick Pivot Turn on Command, or Navigating an Obstacle Course | 81 | ||
| Walking While Carrying a Cup of Water | 81 | ||
| 3 Appendix | 82 | ||
| References | 81.e1 | ||
| 4 Neuroimaging and Neuroanatomy Atlas | 87 | ||
| Chapter Outline | 87 | ||
| Chapter Objectives | 87 | ||
| Computed Tomography | 88 | ||
| Contrast-Enhanced Computed Tomography | 88 | ||
| Magnetic Resonance Imaging | 88 | ||
| T1- and T2-Weighted Magnetic Resonance Imaging | 90 | ||
| Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging | 91 | ||
| Diffusion Imaging | 92 | ||
| Diffusion-Weighted Imaging | 92 | ||
| Diffusion Tensor Imaging | 92 | ||
| Contrast Magnetic Resonance Imaging | 92 | ||
| Neuroangiography | 92 | ||
| Functional Imaging Techniques | 94 | ||
| Positron Emission Tomography | 94 | ||
| Functional Magnetic Resonance Imaging | 94 | ||
| Conclusion | 95 | ||
| Neuroanatomy Imaging Atlas | 95 | ||
| References | 98.e1 | ||
| 2 Neuroscience at the Cellular Level | 99 | ||
| 5 Physical and Electrical Properties of Cells in the Nervous System | 99 | ||
| Chapter Outline | 99 | ||
| Chapter Objectives | 99 | ||
| Introduction | 100 | ||
| Structure of Neurons | 100 | ||
| Components of Neurons | 101 | ||
| Axoplasmic Transport | 102 | ||
| Types of Neurons | 102 | ||
| Bipolar Cells | 102 | ||
| Multipolar Cells | 103 | ||
| Propagation of Information by Neurons | 103 | ||
| Membrane Channels | 103 | ||
| Electrical Potentials | 103 | ||
| Resting Membrane Potential | 103 | ||
| Changes From Resting Membrane Potential | 105 | ||
| Local Potentials and Action Potentials | 105 | ||
| Local Potentials | 105 | ||
| Action Potentials | 108 | ||
| Propagation of Action Potentials | 108 | ||
| Myelination | 110 | ||
| Saltatory Conduction | 110 | ||
| Direction of Information Flow in Neurons | 111 | ||
| Interactions Between Neurons | 111 | ||
| Glia: Signaling and Supporting Cells | 112 | ||
| Myelinating: Oligodendrocytes and Schwann Cells | 112 | ||
| Signaling/Cleaning/Nourishing: Astrocytes | 112 | ||
| Defending: Microglial Cells | 113 | ||
| Neuroinflammation: Beneficial and Harmful Effects | 113 | ||
| Myelin: Clinical Application | 114 | ||
| Peripheral Nervous System Demyelination | 115 | ||
| Central Nervous System Demyelination | 116 | ||
| Neural Stem Cells | 117 | ||
| Summary | 118 | ||
| References | 120.e1 | ||
| 6 Neural Communication | 121 | ||
| Chapter Outline | 121 | ||
| Chapter Objectives | 121 | ||
| Structure of the Synapse | 122 | ||
| Events at the Synapse | 122 | ||
| Electrical Potentials at Synapses | 123 | ||
| Postsynaptic Potentials | 123 | ||
| Excitatory Postsynaptic Potential | 123 | ||
| Inhibitory Postsynaptic Potential | 123 | ||
| Presynaptic Facilitation and Inhibition | 124 | ||
| Neuromessengers: Neurotransmitters and Neuromodulators | 125 | ||
| Synaptic Receptors | 127 | ||
| Ligand-Gated Ion Channels | 127 | ||
| G-Protein Activation of Ion Channels | 128 | ||
| Extrasynaptic Receptors | 128 | ||
| Cascade of Intracellular Events: G-Protein Second-Messenger System | 128 | ||
| Neuromessenger Agonists and Antagonists | 129 | ||
| Specific Neurotransmitters and Neuromodulators | 129 | ||
| Acetylcholine | 129 | ||
| Amino Acids | 130 | ||
| Glutamate | 130 | ||
| Glycine and γ-Aminobutyric Acid | 131 | ||
| Amines | 131 | ||
| Dopamine | 131 | ||
| Norepinephrine | 132 | ||
| Serotonin | 132 | ||
| Histamine | 132 | ||
| Peptides | 132 | ||
| Opioid Peptides | 132 | ||
| Substance P | 133 | ||
| Calcitonin Gene-Related Peptide | 133 | ||
| Nitric Oxide | 133 | ||
| Receptor Regulation | 133 | ||
| Disorders of Synaptic Function | 134 | ||
| Diseases Affecting the Neuromuscular Junction | 134 | ||
| Channelopathy | 135 | ||
| Summary | 135 | ||
| Advanced Diagnostic Clinical Reasoning | 135 | ||
| References | 136.e1 | ||
| 7 Neuroplasticity | 137 | ||
| Chapter Outline | 137 | ||
| Chapter Objectives | 137 | ||
| Habituation | 137 | ||
| Experience-Dependent Plasticity: Learning and Memory | 138 | ||
| Long-Term Potentiation and Depression | 138 | ||
| Transcranial Magnetic Stimulation | 138 | ||
| Astrocytes Contribute to Experience-Dependent Plasticity | 140 | ||
| Metabolic Effects of Brain Injury | 140 | ||
| Axonal Injury | 142 | ||
| Axonal Injury in the Periphery | 142 | ||
| Axonal Injury in the Central Nervous System | 143 | ||
| Cellular Recovery From Injury | 143 | ||
| Synaptic Changes Following Injury | 143 | ||
| Functional Reorganization of the Cerebral Cortex | 145 | ||
| Activity-Related Changes in Neurotransmitter Release | 146 | ||
| Neurogenesis | 146 | ||
| Effects of Rehabilitation on Plasticity | 146 | ||
| Early Rehabilitation | 146 | ||
| Specific Types of Rehabilitation Are Effective During the Chronic Phase Post Stroke | 146 | ||
| Summary | 147 | ||
| Advanced Diagnostic Clinical Reasoning | 148 | ||
| References | 149.e1 | ||
| 3 Development of the Nervous System | 150 | ||
| 8 Development of the Nervous System | 150 | ||
| Chapter Outline | 150 | ||
| Chapter Objectives | 150 | ||
| Developmental Stages in Utero | 151 | ||
| Pre-Embryonic Stage | 151 | ||
| Embryonic Stage | 152 | ||
| Fetal Stage | 152 | ||
| Formation of the Nervous System | 152 | ||
| Formation of the Neural Tube (Days 18 to 26) | 152 | ||
| Relationship of the Neural Tube to Other Developing Structures | 153 | ||
| Brain Formation (Begins Day 28) | 155 | ||
| Continued Development During Fetal Stage | 156 | ||
| Cellular-Level Development | 156 | ||
| Nervous System Changes During Infancy | 158 | ||
| Critical Periods | 158 | ||
| Changes in Neck and Vestibular Reflexes | 159 | ||
| Developmental Disorders: In Utero and Perinatal Damage to the Nervous System | 159 | ||
| Neural Tube Defects | 159 | ||
| Tethered Spinal Cord | 161 | ||
| Spinal Muscular Atrophy | 162 | ||
| Exposure to Alcohol or Cocaine in Utero | 162 | ||
| Abnormal Locations of Cells | 163 | ||
| Intellectual Disability | 163 | ||
| Cerebral Palsy | 163 | ||
| Developmental Coordination Disorder | 165 | ||
| Attention Deficit Hyperactivity Disorder | 165 | ||
| Autism Spectrum Disorders | 166 | ||
| Summary of Developmental Disorders | 167 | ||
| Summary | 167 | ||
| Advanced Diagnostic Clinical Reasoning | 168 | ||
| References | 169.e1 | ||
| 4 Vertical Systems | 170 | ||
| 9 Autonomic Nervous System | 170 | ||
| Chapter Outline | 170 | ||
| Chapter Objectives | 170 | ||
| Receptors | 171 | ||
| Afferent Pathways | 171 | ||
| Central Regulation of Visceral Function | 171 | ||
| Control of Autonomic Functions by the Medulla and Pons | 171 | ||
| Role of the Hypothalamus, Thalamus, and Emotion/Motivation System in Autonomic Regulation | 172 | ||
| Integration of Information | 172 | ||
| Efferent Pathways | 172 | ||
| Differences Between the Somatic Motor System and the Autonomic Efferent System | 173 | ||
| Neurotransmitters Used by the Autonomic Efferent System | 173 | ||
| Cholinergic Neurons and Receptors | 173 | ||
| Adrenergic Neurons and Receptors | 174 | ||
| Sympathetic Nervous System | 175 | ||
| Sympathetic Efferent Neurons | 175 | ||
| Sympathetic Efferents to the Adrenal Medulla | 175 | ||
| Sympathetic Efferents to the Periphery and Thoracic Viscera | 175 | ||
| Sympathetic Efferents to Abdominal and Pelvic Organs | 175 | ||
| Functions of the Sympathetic Nervous System | 176 | ||
| Regulation of Body Temperature | 177 | ||
| Regulation of Blood Flow in Skeletal Muscle | 177 | ||
| Sympathetic Control in the Head | 177 | ||
| Regulation of the Viscera | 177 | ||
| Metabolism | 178 | ||
| Parasympathetic Nervous System | 178 | ||
| Comparison of Sympathetic and Parasympathetic Functions | 180 | ||
| Clinical Correlations | 180 | ||
| Horner’s Syndrome | 180 | ||
| Peripheral Region | 180 | ||
| Spinal Region | 180 | ||
| Brainstem Region | 181 | ||
| Cerebral Region | 181 | ||
| Orthostatic Hypotension | 182 | ||
| Syncope | 183 | ||
| Summary | 183 | ||
| Advanced Diagnostic Clinical Reasoning | 183 | ||
| References | 184.e1 | ||
| 10 Peripheral Somatosensory System | 185 | ||
| Chapter Outline | 185 | ||
| Chapter Objectives | 185 | ||
| Sensory Receptors | 186 | ||
| Somatosensory First-Order Neurons | 186 | ||
| Cutaneous Innervation | 187 | ||
| Peripheral Versus Dermatome Innervation | 187 | ||
| Musculoskeletal Innervation | 188 | ||
| Muscle Spindle | 189 | ||
| Intrafusal and Extrafusal Fibers | 189 | ||
| Golgi Tendon Organs | 191 | ||
| Joint Receptors | 192 | ||
| Function of Different-Diameter Axons | 192 | ||
| Clinical Application | 192 | ||
| Peripheral Nerve Lesions | 192 | ||
| Proprioceptive Pathway Lesions: Sensory Ataxia | 193 | ||
| Sensory Nerve Conduction Studies | 193 | ||
| Summary | 196 | ||
| Advanced Diagnostic Clinical Reasoning | 196 | ||
| References | 196.e1 | ||
| 11 Central Somatosensory System | 197 | ||
| Chapter Outline | 197 | ||
| Chapter Objectives | 197 | ||
| Functions of Somatosensation | 198 | ||
| Contribution of Somatosensory Information to Movement | 198 | ||
| Somatosensory Information Protects Against Injury | 198 | ||
| Pathways to the Brain | 199 | ||
| Conscious Relay Pathways to Cerebral Cortex | 199 | ||
| Light Touch and Conscious Proprioception: Dorsal Column/Medial Lemniscus Pathway | 200 | ||
| Somatosensory Areas of the Cerebral Cortex | 202 | ||
| Somatotopic Arrangement of Information | 202 | ||
| Nociception, Temperature, and Crude Touch: Anterolateral Columns | 202 | ||
| Fast Versus Slow Nociception | 202 | ||
| Discriminative (Fast) Nociception and Temperature and Crude Touch: Spinothalamic Pathway | 203 | ||
| First-Order Neurons in the Spinothalamic Pathway | 203 | ||
| Second-Order and Third-Order Neurons in the Spinothalamic Pathway | 204 | ||
| Fast Nociceptive System: Lateral Nociceptive System | 204 | ||
| Comparison of Dorsal Column/Medial Lemniscus and Spinothalamic Pathways | 204 | ||
| Divergent Pathways With Projection Neurons in the Anterolateral Columns: Slow Nociception, the Medial Nociception System | 204 | ||
| First-Order Neuron | 206 | ||
| Ascending Projection Neurons | 206 | ||
| Spinomesencephalic Tract | 207 | ||
| Spinoreticular Tract | 207 | ||
| Spino-emotional Tract | 207 | ||
| Subconscious Temperature Information | 207 | ||
| Nonconscious Relay Tracts to the Cerebellum: Spinocerebellar Tracts | 208 | ||
| Summary of the Somatosensory System | 208 | ||
| Somatosensory System Lesions | 209 | ||
| Infection: Varicella Zoster (Shingles) | 209 | ||
| Somatosensory Evoked Potentials | 209 | ||
| Clinical Perspectives on Pain | 209 | ||
| Pain From Muscles and Joints | 210 | ||
| Referred Pain | 210 | ||
| The Pain Matrix | 210 | ||
| How Is Pain Controlled? | 212 | ||
| Counterirritant Theory | 213 | ||
| Dorsal Horn Processing of Nociceptive Information | 213 | ||
| Antinociceptive Systems | 213 | ||
| Sites of Antinociception | 214 | ||
| Pronociception: Biologic Amplification of Nociception | 215 | ||
| Chronic Pain | 215 | ||
| Nociceptive Chronic Pain | 215 | ||
| Summary | 218 | ||
| Advanced Diagnostic Clinical Reasoning | 218 | ||
| References | 219.e1 | ||
| 12 Pain as a Disease | 220 | ||
| Chapter Outline | 220 | ||
| Chapter Objectives | 220 | ||
| Chronic Pain as a Disease | 221 | ||
| Neuropathic Pain | 221 | ||
| Symptoms of Neuropathic Pain | 221 | ||
| Four Mechanisms Produce Neuropathic Pain | 222 | ||
| Ectopic Foci | 222 | ||
| Ephaptic Transmission | 224 | ||
| Central Sensitization | 224 | ||
| Structural Reorganization | 225 | ||
| Sites That Generate Neuropathic Pain | 225 | ||
| Peripheral Generation of Neuropathic Pain | 226 | ||
| Central Response to Deafferentation | 226 | ||
| Phantom Pain | 227 | ||
| Central Pain: Spinal Cord Injury, Stroke, and Multiple Sclerosis | 227 | ||
| Small Fiber Neuropathy: Postherpetic Neuralgia, Diabetic Neuropathy, and Guillain-Barré Syndrome | 228 | ||
| Central Sensitivity Syndromes | 228 | ||
| Fibromyalgia | 228 | ||
| Episodic Tension-Type Headache | 229 | ||
| Migraine | 229 | ||
| Red Flags for Headache | 231 | ||
| Chronic Whiplash-Associated Disorder | 231 | ||
| Pain Syndromes | 232 | ||
| Complex Regional Pain Syndrome | 233 | ||
| Chronic Low Back Pain Syndrome | 235 | ||
| Medications for Neuropathic Pain, Fibromyalgia, and Chronic Low Back Pain Syndrome | 236 | ||
| Surgical Treatment of Chronic Pain | 236 | ||
| Psychologic Factors in Chronic Pain | 237 | ||
| Conflicts Between Patient and Provider Goals | 238 | ||
| Summary | 238 | ||
| Advanced Diagnostic Clinical Reasoning | 238 | ||
| References | 240.e1 | ||
| 13 Motor System | 241 | ||
| Chapter Outline | 241 | ||
| Chapter Objectives | 241 | ||
| The Motor System | 242 | ||
| Skeletal Muscle Structure and Function | 242 | ||
| Contraction | 242 | ||
| Total Muscle Resistance to Stretch | 242 | ||
| Muscle Tone: Resistance to Passive Stretch | 242 | ||
| Number of Sarcomeres Adapts to Muscle Length | 245 | ||
| Joint Resistance to Movement and Cocontraction | 245 | ||
| Motor Neurons | 245 | ||
| Motor Neuron Cell Body Pools in the Spinal Cord | 246 | ||
| Myotomes | 246 | ||
| Alpha and Gamma Motor Neurons | 246 | ||
| Alpha-Gamma Coactivation | 246 | ||
| Motor Units | 248 | ||
| Spinal Region Motor Function | 249 | ||
| Spinal Cord Coordination | 249 | ||
| Reciprocal Inhibition | 249 | ||
| Muscle Synergies | 249 | ||
| Proprioceptive Body Schema | 250 | ||
| Role of Golgi Tendon Organs in Movement | 250 | ||
| Spinal Control of Walking: Stepping Pattern Generators | 250 | ||
| Spinal Reflexes | 251 | ||
| Phasic Stretch Reflex: Muscle Spindles | 251 | ||
| Cutaneous Reflex: Withdrawal Reflex | 251 | ||
| Relationship Between Reflexive and Voluntary Movement | 252 | ||
| Involuntary Muscle Contractions | 252 | ||
| Fibrillations | 252 | ||
| Tremors | 252 | ||
| Signs of Motor Neuron Lesions | 253 | ||
| Decrease or Loss of Reflexes | 253 | ||
| Paresis and Paralysis | 253 | ||
| Muscle Atrophy | 253 | ||
| Abnormal Muscle Tone | 253 | ||
| Electrodiagnostic Studies | 253 | ||
| Motor Nerve Conduction Studies | 254 | ||
| Electromyography | 254 | ||
| Muscle Activity at Rest | 254 | ||
| Electromyographic Signs of Denervated and Reinnervated Muscle Versus Myopathy | 255 | ||
| Disorders of Motor Neurons | 255 | ||
| Summary | 256 | ||
| Advanced Diagnostic Clinical Reasoning | 256 | ||
| References | 257.e1 | ||
| 14 Motor System | 258 | ||
| Chapter Outline | 258 | ||
| Chapter Objectives | 258 | ||
| Sensory Contribution to Movement Control | 260 | ||
| Movement Strategies | 260 | ||
| The Central Motor System | 260 | ||
| Motor Tracts to the Spinal Cord | 260 | ||
| Postural and Gross Movements: Medial Motor Tracts | 260 | ||
| Reticulospinal Tract | 262 | ||
| Medial Vestibulospinal Tract | 263 | ||
| Lateral Vestibulospinal Tract | 263 | ||
| Medial Corticospinal TractbEvolving terminology: corticospinal neurons are also known as corticomotoneuronal. Historically, corticospinal was an appropriate term because the sensory regulation function of some corticospinal neurons was undiscovered; now, corticospinal is a somewhat ambiguous term but remains the most commonly used term to describe MTs that arise in the cerebral cortex and terminate in the spinal cord. | 263 | ||
| Fractionated Movements and Distal Limb Movements: Lateral Motor Tracts | 264 | ||
| Rubrospinal Tract | 264 | ||
| Lateral Corticospinal Tract | 264 | ||
| Nonspecific Motor Tracts | 266 | ||
| Control of Muscles in the Head and the Superficial Neck Muscles: Corticobrainstem Tracts | 266 | ||
| Cortical Motor Areas | 266 | ||
| Signs of Motor Tract Lesions | 266 | ||
| Paresis and Paralysis | 267 | ||
| Abnormal Reflexes | 267 | ||
| Abnormal Cutaneous Reflexes | 267 | ||
| Phasic Stretch Hyperreflexia | 269 | ||
| Tonic Stretch Reflex | 269 | ||
| Clonus | 269 | ||
| Clasp-Knife Response | 270 | ||
| Myoplasticity | 271 | ||
| Muscle Disuse Atrophy | 271 | ||
| Abnormal Muscle Tone | 272 | ||
| Flaccidity and Hypotonicity | 272 | ||
| Temporary Hypotonia Owing to Central Nervous System Shock | 272 | ||
| Hypertonia | 272 | ||
| Spasticity: Velocity-Dependent Hypertonia | 273 | ||
| Rigidity | 273 | ||
| Loss of Fractionation of Movement | 273 | ||
| Abnormal Cocontraction | 274 | ||
| Abnormal Muscle Synergies | 274 | ||
| Mechanism of Functional Limitations Depends Upon Site of Lesion and Whether Lesion Occurs Perinatally | 274 | ||
| Spastic Cerebral Palsy: Abnormal Cocontraction, Hyperreflexia, Brainstem Motor Tract Overactivity, and Myoplastic Changes | 274 | ||
| Primary Motor Control Problem in Adult-Onset Motor Tract Syndromes: Paresis and/or Paralysis | 274 | ||
| Middle Cerebral Artery Stroke: Paresis/Paralysis, Loss of Fractionation, Reticulospinal Overactivity, and Myoplastic Changes | 274 | ||
| Paresis and Voluntary Movement Post Stroke | 275 | ||
| Reticulospinal Tract Overactivity | 275 | ||
| Myoplastic Changes Post Stroke | 276 | ||
| Ipsilateral Upper Limb Impairment Post Stroke | 277 | ||
| Spinal Motor Tract Lesions: Paresis, Paralysis, and Hyperreflexia | 278 | ||
| Hyperreflexia in Spinal Cord Injury | 278 | ||
| Contracture | 278 | ||
| Surface Electromyography Differentiates Some Impairments Secondary to Motor Tract Lesions | 278 | ||
| Motor Tract Lesions: Common Characteristics and Differences | 281 | ||
| Interventions for Impairments Secondary to Motor Tract Lesions | 282 | ||
| Spastic Cerebral Palsy | 282 | ||
| Stroke | 283 | ||
| Spinal Cord Injury | 284 | ||
| Medications for Spasticity | 284 | ||
| Stretching Is Ineffective for Contracture Treatment in People With Neurologic Conditions | 286 | ||
| Amyotrophic Lateral Sclerosis | 286 | ||
| Summary | 287 | ||
| Advanced Diagnostic Clinical Reasoning | 287 | ||
| References | 289.e1 | ||
| 15 Motor System | 290 | ||
| Chapter Outline | 290 | ||
| Chapter Objectives | 290 | ||
| Introduction to the Cerebellum | 291 | ||
| Cellular Anatomy of the Cerebellar Cortex | 291 | ||
| Gross Anatomy of the Cerebellum | 291 | ||
| Cerebellar Lobes | 293 | ||
| Cerebellar Peduncles | 293 | ||
| Functional Regions of the Cerebellum | 293 | ||
| Vestibulocerebellum | 294 | ||
| Spinocerebellum | 294 | ||
| Spinocerebellar Pathways and Tracts | 294 | ||
| High-Fidelity Pathways | 294 | ||
| Posterior Spinocerebellar Pathway | 294 | ||
| Cuneocerebellar Pathway | 295 | ||
| Internal Feedback Tracts | 295 | ||
| Anterior Spinocerebellar Tract | 295 | ||
| Rostrospinocerebellar Tract | 295 | ||
| Spinocerebellar Output | 295 | ||
| Cerebrocerebellum | 297 | ||
| Nonessential Cognitive Functions of the Cerebrocerebellum | 298 | ||
| Signs of Cerebellar Dysfunction | 298 | ||
| Differentiating Cerebellar From Somatosensory Ataxia | 299 | ||
| Disorders That Affect the Cerebellum | 299 | ||
| Summary | 300 | ||
| Advanced Diagnostic Clinical Reasoning | 300 | ||
| References | 300.e1 | ||
| 16 Motor and Psychologic Functions | 301 | ||
| Chapter Outline | 301 | ||
| Chapter Objectives | 301 | ||
| Anatomic Orientation to the Basal Ganglia | 302 | ||
| Neurotransmitters and the Basal Ganglia | 302 | ||
| Basal Ganglia Circuitry | 303 | ||
| Goal-Directed Behavior Loop | 303 | ||
| Social Behavior Loop | 304 | ||
| Emotion Loop | 305 | ||
| Oculomotor Loop | 305 | ||
| Motor Loop | 305 | ||
| Hyperdirect, Go, and No-Go Pathways | 306 | ||
| Hyperdirect Pathway | 306 | ||
| Go Pathway | 307 | ||
| No-Go Pathway | 307 | ||
| Basal Ganglia Motor Control | 308 | ||
| Effect of Dopamine on the Go and No-Go Pathways | 309 | ||
| Basal Ganglia Regulation of the Motor Thalamus, the Pedunculopontine Nucleus, and the Midbrain Locomotor Region | 309 | ||
| Basal Ganglia Disorders | 309 | ||
| Hypokinetic Disorders | 309 | ||
| Parkinson’s Disease | 309 | ||
| Postural Instability Gait Difficulty Subtype of Parkinson’s Disease | 309 | ||
| Tremor-Dominant Parkinson’s Disease | 310 | ||
| Pathology in Parkinson’s Disease | 310 | ||
| Treatments for Parkinson’s Disease | 310 | ||
| Parkinson-Plus Syndromes | 315 | ||
| Parkinsonism | 316 | ||
| Hyperkinetic Disorders | 316 | ||
| Huntington’s Disease | 316 | ||
| Dystonia | 317 | ||
| Tourette’s Disorder | 318 | ||
| Dyskinetic Cerebral Palsy | 319 | ||
| Summary of the Basal Ganglia | 319 | ||
| Movement | 319 | ||
| Feedforward and Feedback | 319 | ||
| Three Fundamental Types of Movements | 319 | ||
| Postural Control | 319 | ||
| Ambulation | 320 | ||
| Reaching and Grasping | 320 | ||
| Summary of Normal Motor Control | 321 | ||
| Advanced Diagnostic Clinical Reasoning | 322 | ||
| References | 323.e1 | ||
| 5 Regions | 324 | ||
| 17 Peripheral Region | 324 | ||
| Chapter Outline | 324 | ||
| Chapter Objectives | 324 | ||
| Peripheral Nerves | 325 | ||
| Nerve Plexuses | 326 | ||
| Movement Is Essential for Nerve Health | 327 | ||
| Neuromuscular Junction | 330 | ||
| Dysfunction of Peripheral Nerves | 331 | ||
| Sensory Changes | 331 | ||
| Autonomic Changes | 331 | ||
| Motor Changes | 331 | ||
| Denervation: Trophic Changes | 331 | ||
| Classification of Neuropathies | 331 | ||
| Traumatic Injury to a Peripheral Nerve: Mononeuropathy | 331 | ||
| Traumatic Myelinopathy | 331 | ||
| Traumatic Axonopathy | 333 | ||
| Severance | 333 | ||
| Multiple Mononeuropathy | 334 | ||
| Polyneuropathy | 334 | ||
| Diabetic Polyneuropathy | 334 | ||
| Idiopathic Polyneuropathy | 335 | ||
| Guillain-Barré Syndrome | 335 | ||
| Hereditary Motor and Sensory Neuropathy (Charcot-Marie-Tooth Disease) | 335 | ||
| Dysfunctions of the Neuromuscular Junction | 337 | ||
| Myopathy | 337 | ||
| Electrodiagnostic Studies | 337 | ||
| Clinical Testing | 338 | ||
| Evaluation and Intervention | 339 | ||
| Evaluation | 339 | ||
| Interventions for Peripheral Neuropathy | 339 | ||
| Summary | 340 | ||
| Advanced Diagnostic Clinical Reasoning | 340 | ||
| Appendix 17.1 Distribution of Nerves in the Upper Limbs | 343 | ||
| Appendix 17.2 Distribution of Nerves in the Lower Limbs | 347 | ||
| References | 342.e1 | ||
| 18 Spinal Region | 351 | ||
| Chapter Outline | 351 | ||
| Chapter Objectives | 351 | ||
| Anatomy of the Spinal Region | 352 | ||
| Ventral and Dorsal Roots | 353 | ||
| Segments of the Spinal Cord | 354 | ||
| Spinal Nerves and Rami | 354 | ||
| Internal Structure of the Spinal Cord | 356 | ||
| Meninges | 358 | ||
| Blood Supply | 358 | ||
| Movements of the Spinal Cord and Roots Within the Vertebral Column | 358 | ||
| Functions of the Spinal Cord | 359 | ||
| Classification of Spinal Interneurons | 360 | ||
| Spinal Cord Motor Coordination | 360 | ||
| Stepping Pattern Generators | 361 | ||
| Reflexes | 363 | ||
| Inhibitory Circuits | 364 | ||
| Reciprocal Inhibition | 364 | ||
| Recurrent Inhibition | 365 | ||
| Spinal Control of Pelvic Organ Function | 365 | ||
| Effects of Segmental and Tract Lesions in the Spinal Region | 366 | ||
| Signs of Segmental Dysfunction | 366 | ||
| Signs of Vertical Tract Dysfunction | 368 | ||
| Segmental and Vertical Tract Dysfunction | 369 | ||
| Differentiating Spinal Region From Peripheral Region Lesions | 369 | ||
| Spinal Region Syndromes | 369 | ||
| Effects of Spinal Region Dysfunction on Pelvic Organ Function | 369 | ||
| Traumatic Spinal Cord Injury | 372 | ||
| Abnormal Interneuron Activity in Chronic Spinal Cord Injury | 373 | ||
| Classification of Spinal Cord Injuries | 373 | ||
| Determination of Neurologic Levels | 375 | ||
| Autonomic Dysfunction in Spinal Cord Injury | 375 | ||
| Autonomic Dysreflexia | 376 | ||
| Poor Thermoregulation | 376 | ||
| Orthostatic Hypotension | 377 | ||
| Prognosis and Treatment in Spinal Cord Injury | 377 | ||
| Specific Disorders Affecting Spinal Region Function | 379 | ||
| Myelomeningocele | 379 | ||
| Spastic Cerebral Palsy | 379 | ||
| Lesions of Dorsal and Ventral Nerve Roots | 379 | ||
| Lesions of Dorsal Root Ganglia | 379 | ||
| Multiple Sclerosis | 379 | ||
| Transverse Myelitis | 380 | ||
| Compression in the Spinal Region | 380 | ||
| Spinal Region Tumors | 380 | ||
| Vertebral Canal Stenosis | 380 | ||
| Cervical Stenosis | 380 | ||
| Lumbar Stenosis | 381 | ||
| Syringomyelia | 381 | ||
| Red Flags for the Spinal Region | 381 | ||
| Summary | 381 | ||
| Advanced Diagnostic Clinical Reasoning | 382 | ||
| References | 384.e1 | ||
| 19 Cranial Nerves | 385 | ||
| Chapter Outline | 385 | ||
| Chapter Objectives | 385 | ||
| Cranial Nerve 1: Olfactory | 386 | ||
| Cranial Nerves 2 to 4 and 6: Optic, Oculomotor, Trochlear, and AbducensaCovered in depth in Chapter 21. | 389 | ||
| Cranial Nerve 5: Trigeminal | 389 | ||
| Cranial Nerve 7: Facial | 392 | ||
| Cranial Nerve 8: VestibulocochlearbVestibular nerve function is covered in depth in Chapter 22. | 392 | ||
| Cochlea | 392 | ||
| Converting Sound to Neural Signals | 393 | ||
| Auditory Function Within the Central Nervous System | 394 | ||
| Cranial Nerve 9: Glossopharyngeal | 396 | ||
| Cranial Nerve 10: Vagus | 397 | ||
| Cranial Nerve 11: Accessory | 399 | ||
| Cranial Nerve 12: Hypoglossal | 399 | ||
| Cranial Nerves Involved in Swallowing and Speaking | 400 | ||
| Swallowing | 400 | ||
| Speaking | 400 | ||
| Systems Controlling Cranial Nerve Motor Neurons | 400 | ||
| Descending Control of Motor Cranial Nerves | 400 | ||
| Voluntary Control of Cranial Nerve Motor Neurons: Corticobrainstem Tracts | 400 | ||
| Voluntary Versus Emotional Control of Cranial Nerve Motor Neurons | 400 | ||
| Disorders Affecting Cranial Nerve Function | 401 | ||
| Olfactory Nerve | 401 | ||
| Trigeminal Nerve | 401 | ||
| Trigeminal Neuralgia | 401 | ||
| Facial Nerve | 402 | ||
| Facial Nerve Versus Corticobrainstem Tract Lesions | 402 | ||
| Bell’s Palsy | 402 | ||
| Ramsay Hunt Syndrome | 403 | ||
| Vestibulocochlear Nerve and Disorders of the Auditory System | 403 | ||
| Glossopharyngeal Nerve | 404 | ||
| Vagus Nerve | 404 | ||
| Accessory Nerve | 405 | ||
| Hypoglossal Nerve | 405 | ||
| Dysphagia | 405 | ||
| Dysarthria | 405 | ||
| Summary | 405 | ||
| Advanced Diagnostic Clinical Reasoning | 406 | ||
| References | 406.e1 | ||
| 20 Brainstem Region | 407 | ||
| Chapter Outline | 407 | ||
| Chapter Objectives | 407 | ||
| Anatomy of the Brainstem | 408 | ||
| Vertical Tracts in the Brainstem | 408 | ||
| Longitudinal Sections of the Brainstem | 408 | ||
| Reticular Formation | 408 | ||
| Reticular Nuclei and Their Neurotransmitters/Neuromodulators | 410 | ||
| Ventral Tegmental Area: Dopamine | 410 | ||
| Pedunculopontine Nucleus: Acetylcholine | 410 | ||
| Raphe Nuclei: Serotonin | 411 | ||
| Locus Coeruleus and Medial Reticular Zone: Norepinephrine | 411 | ||
| Regulation of Consciousness by the Ascending Reticular Activating System | 411 | ||
| Medulla | 411 | ||
| External Anatomy of the Medulla | 412 | ||
| Inferior Medulla | 412 | ||
| Upper Medulla | 413 | ||
| Functions of the Medulla | 413 | ||
| Pons | 414 | ||
| Midbrain | 416 | ||
| Basis Pedunculi | 416 | ||
| Midbrain Tegmentum | 416 | ||
| Midbrain Tectum | 416 | ||
| Cerebellum | 416 | ||
| Arterial Supply to the Brainstem and Cerebellum | 416 | ||
| Brainstem Rule of Four: Method for Recalling Brainstem Anatomy and Arterial Supply | 416 | ||
| Disorders in the Brainstem Region | 417 | ||
| Vertical Tract Signs | 417 | ||
| Corticobrainstem Tract Lesions | 417 | ||
| Contralateral and Ipsilateral Signs | 419 | ||
| Disorders of Vital Functions | 419 | ||
| Four Ds of Brainstem Region Dysfunction | 419 | ||
| Disorders of Consciousness | 419 | ||
| Tumors in the Brainstem Region | 423 | ||
| Brainstem Region Ischemia | 423 | ||
| Summary | 424 | ||
| Advanced Diagnostic Clinical Reasoning | 424 | ||
| References | 425.e1 | ||
| 21 Visual System | 426 | ||
| Chapter Outline | 426 | ||
| Chapter Objectives | 426 | ||
| Visual System | 427 | ||
| Sight: Information Conveyed From Retina to Cortex | 427 | ||
| First Neuron: From Retina Through Optic Nerve, Chiasm, and Tract to the Lateral Geniculate Nucleus | 427 | ||
| Second Neuron: Lateral Geniculate Body to Primary Visual Cortex | 427 | ||
| Cortical Destination of Visual Information | 427 | ||
| Processing of Visual Information | 428 | ||
| Disorders of the Visual System | 428 | ||
| Optic Nerve Lesions | 428 | ||
| Visual Field Deficits | 428 | ||
| Cortical Blindness and Blindsight | 429 | ||
| Cranial Nerve 3: Oculomotor Parasympathetic Efferents for the Pupillary Light Reflex and the Near Triad | 430 | ||
| The Pupillary Light Reflex | 430 | ||
| The Near Triad | 431 | ||
| Cranial Nerves 3, 4, and 6: Oculomotor, Trochlear, and Abducens: Control of Eye Movements | 432 | ||
| Extraocular Muscles | 432 | ||
| Coordination of Eye Movements: Medial Longitudinal Fasciculus | 433 | ||
| Disorders Affecting Cranial Nerves 3, 4, and 6 or the Medial Longitudinal Fasciculus | 433 | ||
| Oculomotor Nerve | 434 | ||
| Trochlear Nerve | 435 | ||
| Abducens Nerve | 435 | ||
| Medial Longitudinal Fasciculus | 435 | ||
| The Eye Movement System | 435 | ||
| Types of Eye Movements | 436 | ||
| Gaze Stabilization: Vestibulo-ocular Reflexes, Optokinetic Nystagmus, Physiologic Versus Pathologic Nystagmus | 436 | ||
| Vestibulo-ocular Reflexes | 436 | ||
| Optokinetic Nystagmus | 437 | ||
| Physiologic Versus Pathologic Nystagmus | 438 | ||
| Direction of Gaze: Saccades, Smooth Pursuits, and Convergence | 439 | ||
| Saccades | 439 | ||
| Smooth Pursuit Eye Movements | 439 | ||
| Convergence Eye Movements | 441 | ||
| Disorders of the Eye Movement System | 441 | ||
| Motion Sickness | 442 | ||
| Summary | 443 | ||
| Advanced Diagnostic Clinical Reasoning | 443 | ||
| References | 443.e1 | ||
| 22 Vestibular System | 444 | ||
| Chapter Outline | 444 | ||
| Chapter Objectives | 444 | ||
| Peripheral Vestibular System | 445 | ||
| Vestibular Apparatus | 445 | ||
| Semicircular Canals | 445 | ||
| Otolithic Organs | 447 | ||
| Vestibular Nerve | 448 | ||
| Signs and Symptoms of Vestibular Disorders | 448 | ||
| Peripheral Vestibular Disorders | 448 | ||
| Benign Paroxysmal Positional Vertigo: Canalithiasis | 449 | ||
| Atypical Benign Paroxysmal Positional Vertigo: Cupulolithiasis | 451 | ||
| Vestibular Neuritis | 451 | ||
| Ménière’s Disease | 451 | ||
| Traumatic Injury | 451 | ||
| Perilymph Fistula | 451 | ||
| Bilateral Lesions of the Vestibular Nerve | 451 | ||
| Central Vestibular System | 451 | ||
| Vestibular Role in Motor Control | 451 | ||
| Perception: Inhibitory Visual-Vestibular Interaction in the Cerebral Cortex | 453 | ||
| Central Vestibular Disorders | 453 | ||
| Lesions of the Vestibulothalamocortical Pathway or Vestibular Cortex | 454 | ||
| Vestibular Migraine | 454 | ||
| Persistent Postural-Perceptual Dizziness | 454 | ||
| Unilateral Vestibular Loss | 454 | ||
| Bilateral Vestibular Loss | 455 | ||
| Evaluating the Vestibular System | 455 | ||
| Differentiating Vestibular, Cerebellar, and Sensory Ataxia: Lower Limb Coordination Tests | 455 | ||
| Sensory Testing | 456 | ||
| Specialty Clinic Testing of Vestibulo-Ocular Reflexes | 456 | ||
| Rehabilitation in Vestibular Disorders | 456 | ||
| Summary | 457 | ||
| Advanced Diagnostic Clinical Reasoning | 457 | ||
| References | 458.e1 | ||
| 23 Dizziness and Unsteadiness | 459 | ||
| Chapter Outline | 459 | ||
| Chapter Objectives | 459 | ||
| Introduction | 459 | ||
| Traditional Versus Evidence-Based Approach to Dizziness and Unsteadiness | 460 | ||
| General Approach to Differential Diagnosis of Dizziness | 460 | ||
| Timing | 460 | ||
| Triggers | 460 | ||
| Oculomotor Signs | 460 | ||
| Provocative Tests for Specific Indications | 461 | ||
| Other Targeted Tests | 461 | ||
| Frequency of Specific Causes of Dizziness/Unsteadiness | 462 | ||
| The Diagnostic Process: How to Use the Appendices | 462 | ||
| Appendix A How to Categorize Acute Onset Dizziness | 463 | ||
| Appendix A1 Differential Diagnosis: Acute Onset Triggered Episodic Dizziness | 464 | ||
| Appendix A2 Differential Diagnosis: Acute Onset Spontaneous Episodic Dizziness | 466 | ||
| Appendix A3 Differential Diagnosis: Acute Onset Spontaneous Continuous Dizziness | 468 | ||
| Appendix A4 Differential Diagnosis: Acute Onset Traumatic/Toxic Continuous Dizziness | 469 | ||
| Screening Questions for Traumatic/Toxic Dizziness | 469 | ||
| Traumatic Dizziness | 469 | ||
| Dizziness Caused by Toxins | 469 | ||
| Appendix B How to Categorize Chronic Duration Dizziness and Unsteadiness | 470 | ||
| Appendix B1 Differential Diagnosis: Triggered Chronic Dizziness and Unsteadiness | 471 | ||
| Appendix B2 Differential Diagnosis: Spontaneous Chronic Dizziness and Unsteadiness | 472 | ||
| References | 462.e1 | ||
| 24 Cerebrospinal Fluid System | 473 | ||
| Chapter Outline | 473 | ||
| Chapter Objectives | 473 | ||
| Cerebrospinal Fluid System | 473 | ||
| Ventricles | 473 | ||
| Meninges | 474 | ||
| Formation and Circulation of Cerebrospinal Fluid | 474 | ||
| Clinical Disorders of the Cerebrospinal Fluid System | 475 | ||
| Epidural and Subdural Hematomas | 475 | ||
| Hydrocephalus | 476 | ||
| Meningitis | 476 | ||
| Craniosacral Therapy | 477 | ||
| Summary | 477 | ||
| Advanced Diagnostic Clinical Reasoning | 477 | ||
| References | 477.e1 | ||
| 25 Blood Supply, Stroke, Fluid Dynamics, and Intracranial Pressure | 478 | ||
| Chapter Outline | 478 | ||
| Chapter Objectives | 478 | ||
| Disorders of Vascular Supply | 479 | ||
| Types of Stroke | 480 | ||
| Brain Infarction | 480 | ||
| Hemorrhage | 482 | ||
| Subarachnoid Hemorrhage | 482 | ||
| Stroke Signs and Symptoms by Arterial Location | 483 | ||
| Vertebral and Basilar Artery Stroke (see Fig. 25.2) | 483 | ||
| Cerebral Artery Stroke (see Figs. 25.2A and 25.3) | 484 | ||
| Anterior Cerebral Artery | 484 | ||
| Middle Cerebral Artery | 484 | ||
| Posterior Cerebral Artery | 485 | ||
| Watershed Area | 485 | ||
| Disorders of Vascular Formation | 485 | ||
| Arteriovenous Malformations | 485 | ||
| Aneurysm | 485 | ||
| Fluid Dynamics | 485 | ||
| Blood-Brain Barrier | 485 | ||
| Cerebral Blood Flow | 485 | ||
| Cerebral Edema | 487 | ||
| Intracranial Pressure | 487 | ||
| Brain Herniations (Fig. 25.13) | 488 | ||
| Cingulate Herniation | 488 | ||
| Uncal Herniation | 488 | ||
| Central Herniation | 488 | ||
| Tonsillar Herniation | 488 | ||
| Review of Evaluation of Cerebral Blood Flow | 488 | ||
| Venous System | 488 | ||
| Summary | 489 | ||
| Advanced Diagnostic Clinical Reasoning | 489 | ||
| References | 490.e1 | ||
| 26 Cerebrum | 491 | ||
| Chapter Outline | 491 | ||
| Chapter Objectives | 491 | ||
| Introduction | 492 | ||
| Diencephalon | 492 | ||
| Thalamus | 492 | ||
| Thalamic Lesions | 493 | ||
| Lateropulsion: Lesion of the Posterior Thalamus or Vestibular Nuclei | 493 | ||
| Hypothalamus | 494 | ||
| Hypothalamus and Pituitary Gland | 494 | ||
| Hormones Released From the Anterior Pituitary Gland | 495 | ||
| Neurohormones Released From the Posterior Pituitary Gland | 495 | ||
| Pituitary Tumors | 496 | ||
| Epithalamus | 497 | ||
| Subthalamus | 497 | ||
| Subcortical Structures | 497 | ||
| Subcortical White Matter | 497 | ||
| Projection Fibers: Internal Capsule | 497 | ||
| Commissural Fibers | 497 | ||
| Association Fibers | 500 | ||
| Subcortical White Matter Lesions | 500 | ||
| Internal Capsule | 500 | ||
| Callosotomy | 500 | ||
| Basal Ganglia | 500 | ||
| Cerebral Cortex | 500 | ||
| Mapping of the Cerebral Cortex | 501 | ||
| Localized Functions of the Cerebral CortexaIn neuroscience, the term localization of function is used to connote that an area contributes to the performance of a specific neural activity. Neural functions are achieved by networks of neurons, not by isolated centers. | 502 | ||
| Primary Sensory Areas of the Cerebral Cortex | 502 | ||
| Primary Somatosensory Cortex | 502 | ||
| Primary Auditory and Primary Vestibular Cortices | 502 | ||
| Primary Visual Cortex | 502 | ||
| Primary Sensory Area Lesions: Loss of Discriminative Sensory Information | 503 | ||
| Perception | 503 | ||
| Secondary Sensory Areas | 503 | ||
| Use of Visual Information: Action and Perceptual Streams | 504 | ||
| Lesions Affecting Secondary Sensory Areas: Agnosia | 504 | ||
| Astereognosis | 505 | ||
| Visual Agnosia: Lesion in the Ventral Visual Stream | 505 | ||
| Auditory Agnosia | 505 | ||
| Optic Ataxia: Lesion in the Dorsal Visual Stream | 505 | ||
| Primary Motor Cortex | 505 | ||
| Primary Motor Cortex Lesions: Loss of Movement Fractionation and Dysarthria | 505 | ||
| Alien Hand Syndrome: Isolated Activation of the Primary Motor Cortex | 505 | ||
| Cortical Motor Planning Areas | 506 | ||
| Connections of the Motor Areas | 507 | ||
| Motor Planning Area Disorders: Apraxia, Motor Perseveration, Broca’s Aphasia, and Impaired Nonverbal Communication | 507 | ||
| Association Areas of the Cerebral Cortex | 507 | ||
| Diseases That Affect a Variety of Cerebral Structures | 507 | ||
| Cerebral Stroke | 507 | ||
| Signs and Symptoms of Stroke | 507 | ||
| Recovery From Stroke | 508 | ||
| Tumors | 508 | ||
| Epilepsy | 508 | ||
| Summary | 509 | ||
| Advanced Diagnostic Clinical Reasoning | 509 | ||
| References | 510.e1 | ||
| 27 Memory, Consciousness, and Intellect | 511 | ||
| Chapter Outline | 511 | ||
| Chapter Objectives | 511 | ||
| Memory | 511 | ||
| Working Memory | 511 | ||
| Declarative Memory | 512 | ||
| Episodic Versus Semantic Declarative Memory | 514 | ||
| Declarative Memory Failure: Amnesia | 514 | ||
| Procedural Memory | 515 | ||
| Consciousness | 515 | ||
| Limits of Attention | 516 | ||
| Disorders Affecting the Consciousness System | 517 | ||
| Loss of Consciousness | 517 | ||
| Impaired Attention | 517 | ||
| Attention Deficit Hyperactivity Disorder | 517 | ||
| Intellect | 518 | ||
| Disorders of Intellect | 518 | ||
| Trisomy 21 | 518 | ||
| Phenylketonuria | 518 | ||
| Learning Disabilities | 518 | ||
| Dementia | 518 | ||
| Alzheimer’s Disease | 518 | ||
| Frontotemporal Dementia | 519 | ||
| Dementia in Parkinson’s, Parkinson-Plus Syndromes, and Chronic Traumatic Encephalopathy | 519 | ||
| Summary | 520 | ||
| Advanced Diagnostic Clinical Reasoning | 520 | ||
| References | 521.e1 | ||
| 28 Behavior, Emotions, Decision Making, Personality | 522 | ||
| Chapter Outline | 522 | ||
| Chapter Objectives | 522 | ||
| Introduction | 523 | ||
| Association Areas of the Cerebral Cortex | 523 | ||
| Goal-Directed Behavior and Divergent Thinking | 524 | ||
| Lateral Prefrontal Cortex and the Goal-Directed Behavior Loop | 524 | ||
| Lateral Prefrontal Cortex Lesions: Loss of Goal-Directed Behavior and Divergent Thinking | 524 | ||
| Emotions, Self-Awareness, and Motivation | 524 | ||
| Medial Prefrontal Association Cortex | 525 | ||
| Medial Prefrontal Association Cortex Lesions: Apathy, Lack of Emotions and Insight | 525 | ||
| Identifying Emotional Stimuli, Generating and Perceiving Emotions | 525 | ||
| The Emotion Loop | 526 | ||
| Regulating Emotions | 526 | ||
| Emotional Lability | 526 | ||
| Motivation | 526 | ||
| Ventral Striatum Disorders | 527 | ||
| Motivation: The Reward-Seeking Pathway and Addiction | 527 | ||
| Motivation: The Avoidance-Seeking Pathway | 527 | ||
| Social Behavior | 527 | ||
| The Ventral Prefrontal Cortex and the Social Behavior Loop | 527 | ||
| Social Decision Making and the Somatic Marker Hypothesis | 529 | ||
| Ventral Prefrontal Cortex Lesions: Inappropriate Social Behavior | 529 | ||
| Personality Characteristics | 530 | ||
| Psychologic and Somatic Interactions | 530 | ||
| Neurologic/Psychiatric Signs and Symptoms | 531 | ||
| Psychiatric Disorders | 532 | ||
| Personality Disorders | 532 | ||
| Anxiety Disorders | 532 | ||
| Depression | 533 | ||
| Somatic Symptom Disorder: Misattributed Causation | 533 | ||
| Autism Spectrum Disorders | 533 | ||
| Bipolar Disorder | 533 | ||
| Schizophrenia | 533 | ||
| Traumatic Brain Injury | 534 | ||
| Summary | 535 | ||
| References | 536.e1 | ||
| 29 Communication, Directing Attention, and Spatial Cognition | 537 | ||
| Chapter Outline | 537 | ||
| Chapter Objectives | 537 | ||
| Introduction | 537 | ||
| Communication | 537 | ||
| Language | 537 | ||
| Language Disorders | 538 | ||
| Nonverbal Communication | 540 | ||
| Disorders of Nonverbal Communication | 540 | ||
| Directing Attention | 540 | ||
| Spatial Perception | 540 | ||
| Neglect | 540 | ||
| Personal Neglect | 540 | ||
| Spatial Neglect | 542 | ||
| Frequency of Neglect and Clinical Importance | 542 | ||
| Hemispheric Specialization | 542 | ||
| Summary of Cerebral Hemisphere Function | 545 | ||
| Advanced Diagnostic Clinical Reasoning | 545 | ||
| References | 548.e1 | ||
| Index | 549 | ||
| A | 549 | ||
| B | 550 | ||
| C | 550 | ||
| D | 552 | ||
| E | 553 | ||
| F | 553 | ||
| G | 553 | ||
| H | 554 | ||
| I | 554 | ||
| J | 554 | ||
| K | 554 | ||
| L | 554 | ||
| M | 555 | ||
| N | 556 | ||
| O | 557 | ||
| P | 557 | ||
| Q | 558 | ||
| R | 558 | ||
| S | 559 | ||
| T | 560 | ||
| U | 561 | ||
| V | 561 | ||
| W | 562 | ||
| Z | 562 |