Term
| The functional division of the peripheral nervous system that innervates smooth muscle, cardiac muscle, and glands. |
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Definition
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Term
| This system includes both sensory and motor fibers (GVA and GVE) |
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Definition
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Term
| This system acts on an unconscious level to regulate the activity of visceral organs. |
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Definition
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Term
| The ANS is controlled by the __ through pathways traveling in the dorsal longitudinal fasciculus. |
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Definition
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Term
| Neurons in the ANS innervate their targest indirectly, utilizing a what? |
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Definition
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Term
| Neuron 1 is what type of neuron? |
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Definition
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Term
| Neuron 2 is what type of neuron? |
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Definition
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Term
| This neuron has its cell body inside the CNS. The axons of this neuron terminates on the cell body of the other neuron. |
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Definition
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Term
| This neuron has its cell body outside of the CNS. The axon of this neuron terminates on the target organ. |
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Definition
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Term
| Name the 2 primary divisions of the ANS |
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Definition
Sympathetic
Parasympathetic |
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Term
| Preganglionic neurons located in the thoracic and upper 2 lumbar segments of the spinal cord. |
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Definition
| Sympathetic Nervous System |
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Term
| The preganglionic neurons located in the thoracic and upper 2 lumbar segments of the spinal cord can also be referred to as what? |
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Definition
| Intermediolateral cell column |
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Term
| The preganglionic axons exit the spinal cord in the thoracic and lumbar nerves; travel from the spinal nerves to the sympathetic chain via what? |
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Definition
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Term
| Some preganglionic axons synapse in the sympathetic chain, while others just pass through the chain to reach what? |
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Definition
| Postganglionic cells in other ganglia |
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Term
| Axons from the sympathetic chain exit the ganglia and rejoin the spinal nerves via what? |
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Definition
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Term
| A group of neuronal cell bodies located outside the CNS |
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Definition
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Term
| Sympathetic postganglionic neurons are located in one of three structures. Name the 3. |
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Definition
1. Sympathetic Chain
2. Prevertebral Ganglia
3. Adrenal Medulla |
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Term
| Interconnected chain of ganglia located close to the spinal cord. |
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Definition
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Term
| Ganglia located in the abdomen and associated with major arteries of the abdomen (celiac, superior and inferior mesenteric) |
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Definition
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Term
| Considered a displaced sympathetic ganglion. |
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Definition
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Term
| A bunch of sympathetic postganglionic neurons sitting on top of the kidneys |
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Definition
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Term
| Are preganglionic axons short or long in the sympathetic nervous system? |
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Definition
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Term
| Are postganglionic axons short or long in the sympathetic nervous system? |
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Definition
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Term
| Sympathetic nervous system preganglionic fibers are generally short, with postganglionic neurons located __ from the target organs. |
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Definition
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Term
| What neurotransmitter is found in the preganglionic neurons of the sympathetic nervous system? |
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Definition
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Term
| What neurotransmitter is found in the postganglionic neurons of the sympathetic nervous system? |
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Definition
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Term
| Activation of the sympathetic nervous system causes the fight or flight response. Name 7 body responses that occur. |
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Definition
1. Increase HR
2. Decreased peristalsis
3. Increased BP
4. Dilation of coronary arteries
5. Dilation of bronchioles
6. Shunting of blood away from the gut and toward skeletal muscles
7. Dilation of pupils |
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Term
| The systemic response is caused by what 2 things? |
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Definition
1. Pain
2. Strong Emotions (Rage, Fear) |
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Term
| Cell bodies here are either located in the brain stem or in the sacral spinal cord. |
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Definition
| Parasympathetic nervous system |
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Term
| Are preganglionic axons long or short in the parasympathetic nervous system? |
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Definition
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Term
| Are postganglionic axons long or short in the parasympathetic nervous system? |
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Definition
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Term
| Also known as Thoracolumbar Outflow) |
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Definition
| Sympathetic Nervous System |
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Term
| Also known as Craniosacral Outflow? |
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Definition
| Parasympathetic Nervous System |
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Term
| Preganglionic neurons of the parasympathetic nervous system are located where? |
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Definition
Cranial nerve nuclei III, VII, IX, X
and sacral segments 2 thru 4 |
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Term
| Postganglionic neurons of the parasympathetic nervous system are located where? |
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Definition
| in ganglia within, or very close to the target organs |
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Term
| What is the pre and postganglionic neurotransmitter of the parasympathetic system? |
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Definition
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Term
| Activation of the parasympathetic nervous system causes rest and digest. List the 5 bodily responses. |
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Definition
1. Decreased cardiac output
2. Decreased BP
3. Increased peristalsis
4. Contraction of bladder
5. Pupillary constriction |
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Term
| Which nervous system has more of a discrete response? Sympathetic or Parasympathetic |
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Definition
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Term
| Which nervous system has more of a whole body response? Sympathetic or Parasympathetic |
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Definition
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Term
| This pathology of the ANS involves a lack of hypothalamic control and occurs in patients with SCI above T6 |
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Definition
| Autonomic Dysreflexia in SCI |
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Term
| This pathology of the ANS results in uncontrolled stimulation of the sympathetics. |
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Definition
| Autonomic Dysreflexia in SCI |
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Term
| The mechanism for this pathology involving the ANS include: 1. visceral stimuli along sympathetic afferents 2. exaggerated response to visceral afferent input at spinal level due to abscence of hypothalamic control of ANS 3. Increased sympathetic efferent output |
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Definition
| Autonomic Dysreflexia in SCI |
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Term
| Name 5 symptoms of a patient with Autonomic Dysreflexia in ANS |
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Definition
1. Severe headache
2. Dramatic increase in BP
3. Pallor below lesion; flushing above
4. Profuse diaphoresis above lesion
5. Blurred vision |
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Term
| Is Autonomic Dysreflexia in SCI a medical emergency? |
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Definition
| Yes because of increased BP and increased HR |
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Term
| A regional pain disorder disproportionate to any precipitating event and is characterized by pain, autonomic abnormalities, motor symptoms, and trophies changes. |
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Definition
| CRPS - Complex Regional Pain Syndrome |
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Term
| What are the 2 main classifications of CRPS that depend on the precipitating lesion |
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Definition
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Term
| What is CRPS I formerly known as |
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Definition
| Reflex Sympathetic Dystrophy / Shoulder-Hand Syndrome |
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Term
| What is CRPS II formerly known as |
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Definition
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Term
| This classification of CRPS is where patients typically develop the syndrome following initial painful event (sprain, strain, etc) that may or may not have been traumatic. |
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Definition
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Term
| This classification of CRPS is where the precipitating even includes injury to a major peripheral nerve. |
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Definition
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Term
| In order for CRPS to be diagnosed, the following criteria must be met. (4) |
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Definition
1. Preceding noxious event without (CRPS I) or with (CRPS II) obvious nerve lesion
2. Spontaneous pain or hyperalgesia / hyperesthesia not limited to a single nerve territory and disproportionate to the inciting events.
3. Edema, skin blood flow or sudomotor abnormalities, motor symptoms, or trophic changes are present on affected limb, in particular at distal sites
4. Other diagnoses (stress fracture, bone tumors, inflammatory arthritis, etc.) are excluded |
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Term
| What is the most common symptom of CRPS |
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Definition
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Term
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Definition
| Burning, throbbing, shooting, or aching pain |
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Term
| Name a 4 pain characteristic of CRPS |
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Definition
1. Spreads beyond area of initial injury
2. Disproportionate to inciting injury
3. Increased pain when limb dependent
4. May involve entire extremity or even the contralateral limb |
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Term
| Disproportionately increased pain response to mildly noxious stimulus |
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Definition
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Term
| Pain response to non-noxious stimulus |
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Definition
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Term
| Posture, protective clothing, resist being touched |
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Definition
| Patients protective of limbs |
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Term
| The affected limb may be warmer than the unaffected limb in acute stages; in chronic stages it may be the reverse |
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Definition
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Term
| In acute stagest, there may be swelling in what part of the extremity? |
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Definition
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Term
| Name 2 sudomotor changes you may see with CRPS |
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Definition
Hyperhidrosis
Hypohidrosis |
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Term
| Which one is most common, hyper or hypo hidrosis? |
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Definition
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Term
| Will there be weakness of the distal extremity muscles with CRPS? |
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Definition
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Term
| With CRPS will there be impaired fine motor skills? |
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Definition
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Term
| In CRPS, will EMG and NCV be normal? |
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Definition
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Term
| Do most patients with CRPS have a tremor? |
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Definition
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Term
| Will you see hyperreflexia in a patient with CRPS? |
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Definition
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Term
| Name 4 trophic changes in a patient with CRPS |
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Definition
1. Abnormal Nail growth
2. Changes in hair growth
3. Contractures/fibrosis
4. Skin atrophy later |
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Term
| When is a person at risk for contractures? |
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Definition
| When they do not use their limb |
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Term
| CRPS is not completely understood. It appears to be some SNS component, though not completely confirmed. Some patients have ___ that can be alleviated by a sympathetic block |
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Definition
| Sympathetically maintained pain (SMP) |
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Term
| In CRPS, nociceptors appear to have __ sensitivity to norepinephrine, probably due to up-regulation of alpha-adrenoreceptors |
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Definition
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Term
| Central mechanisms such as what are probably invoved in CRPS |
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Definition
Brain plasticity
Reorganization of cortex in response to altered sensory inputs |
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Term
| What can medically be done to help a patient with CRPS |
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Definition
decrease the swelling (corticosteroids)
control pain (opiods, sympatholytic drugs, sympathetic block, epidural, spinal cord stimulation) |
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Term
| Name 4 things that a PT can do for a patient with CRPS |
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Definition
1. Desensitize the extremity
2. Increase ROM
3. Increase pain free function
4. Restore strength |
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Term
| What is done (normally outside the US) for severe cases of CRPS |
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Definition
| Ketamine induced comas as a last resort to help the nervous system rest and calm itself. It has worked in 50% of patients |
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