Neuroscience: Fundamentals for Rehabilitation

Front Cover
Inside Front Cover
Neuroscience
Copyright Page
Contributors
Preface
	Distinctive Features of This Text Include
	Learning Aids
Acknowledgments
Table Of Contents
1 Introduction to Neuroscience
	Chapter Outline
	Analysis of the Nervous System
	What Do We Learn From These Studies?
	Organization of This Book
	Diagnostic Clinical Reasoning
	Reference
1 Overview of Neurology
	2 Neuroanatomy
		Chapter Outline
		Chapter Objectives
		Introduction to Neuroanatomy
		Introduction to the Atlas
		Cellular-Level Neuroanatomy
		Peripheral Nervous System
		Central Nervous System
			Spinal Region
			Brainstem and Cerebellar Region
				Cranial Nerves
				Cerebellum
			Cerebrum
				Diencephalon
				Cerebral Hemispheres
		Cerebrospinal Fluid System: Ventricles and Meninges
		Blood Supply
			Blood Supply to the Brainstem and Cerebellum
			Blood Supply to Cerebral Hemispheres
				Circle of Willis
				Cerebral Arteries
		Summary
		Atlas
	3 Neurologic Disorders and the Neurologic Examination
		Chapter Outline
		Chapter Objectives
		Clinical Application of Learning Neuroscience
		Neurologic Disorders
			Incidence and Prevalence of Neurologic Disorders
		Neurologic Examination
			History
			Tests and Measures
		Diagnosis
		Neurologic Screening Examination
		Comprehensive Neurologic Examination
		Special Tests
		TESTS of Neurologic Function
		Mental Status Testing
			Consciousness Level
			Attention: World Test or Digit Span Test (Screening Test)
			Language and Speech
				Comprehension
				Naming
				One-Minute Category Naming Test
				Reading
				Writing
			Orientation
			Declarative Memory (Memory of Facts and Events; Screening Test)
				Working Memory
				Recent Memory
				Long-Term Memory
			Goal-Directed Behavior (Also Known as Executive Function; Screening Test)
				One-Minute Naming Test: Initial Letter
			Calculation
			Stereognosis (Special Test)
			Visual Identification (Special Test)
			Bilateral Simultaneous Stimulation (Special Test)
				Touch
				Vision
			Motor Planning
			Comprehension of Spatial Relationships (Special Tests)
				Activities of Daily Living
				Drawing
				Visual Scanning
				Body Scheme Drawing
				Concept of Relationship of Body Parts
				Orientation to Vertical Position
		Cranial Nerve Observation and Testing
			Olfactory Nerve (Cranial Nerve 1) (Special Test)
			Optic Nerve (Cranial Nerve 2)
				Visual Fields (Screening Test)
				Cranial Nerves 2 and 3: Pupillary Light Reflex (Screening Test)
			Oculomotor Nerve (Cranial Nerve 3)
				Upper Eyelid Position and Raising the Upper Eyelid (Screening Test)
				Pupillary Responses
					Observe Size of Pupils in Room Light
					Pupillary Response to Light
					Pupillary Response to Near and Far Objects
				Convergence
			Gaze Stability and Extraocular Movements (Cranial Nerves 3, 4, and 6)
				Forward Gaze (Screening Test)
				Eye Alignment (Special Tests)
					Cover Test
					Cover-Uncover and Alternate Cover Tests
				Smooth Pursuit Eye Movements (Screening Test)
					Oculomotor Nerve (Cranial Nerve 3) Smooth Pursuits
					Trochlear Nerve (Cranial Nerve 4) Smooth Pursuits
					Abducens Nerve (Cranial Nerve 6) Smooth Pursuits
				Differential Diagnosis: Cranial Nerve 3, 4, or 6 Lesions Versus Supranuclear or Medial Longitudinal Fasciculus Lesions
			Tests for Oculomotor Centers and Pathways That Control Eye Movements
				Voluntary Saccades
				Optokinetic Nystagmus (Special Test)
				Dynamic Visual Acuity (Special Test)
				Nystagmus
					Physiologic Nystagmus
					Pathologic Nystagmus (Special Tests)
						Spontaneous Nystagmus, Eyes Open.
						Nystagmus, Eyes Closed.
						Eccentric Gaze Holding Nystagmus.
			Trigeminal Nerve (Cranial Nerve 5)
				Light Touch Testing (Screening Test)
				Sharp Versus Dull Sensation: Pinprick
				Corneal Reflex
				Jaw Deviation and Jaw Closing
				Jaw Jerk Reflex (Not Recommended)
			Facial Nerve (Cranial Nerve 7) (Screening Test)
			Vestibulocochlear Nerve (Cranial Nerve 8)
				Hearing Tests That Examine the Cochlear Branch of Cranial Nerve 8
					Hearing Screening Using Finger Rub (Screening Test)
					Rinne Test (Special Test)
					Weber Test (Special Test)
				Vestibular Branch
					Past Pointing Test (Screening Test)
					Head Impulse Test: Vestibulo-Ocular Reflex (Special Test)
			Tests to Determine Causes of Dizziness
				Head Position Nystagmus Test for Paroxysmal Positional Vertigo: Dix-Hallpike Maneuver (Special Test)
				Supine Roll to Side Test (Special Test)
				Oculomotor Control: HINTS Examination: Head-Impulse—Nystagmus—Test-of-Skew (Special Test)
			Glossopharyngeal Nerve (Cranial Nerve 9)
			Vagus Nerve (Cranial Nerve 10)
			Accessory Nerve (Cranial Nerve 11)
			Hypoglossal Nerve (Cranial Nerve 12)
				Tongue Protrusion (Screening Test)
				Manual Resistance of Tongue Movement
		Autonomic Testing
			Orthostatic Hypotension Test (Screening Test)
			Observe the Appearance of the Skin (Screening Test)
			Bladder, Bowel, and Sexual Functions
		Motor Testing
			Muscle Power
				Quick Muscle Power Tests (Screening Test)
				Manual Muscle Test
				Pronator Drift (Special Test)
			Muscle Bulk (Visual Inspection Is a Screening Test)
			Muscle Tone: Muscle Resistance to Passive Stretch (Screening Test)
				Ashworth Scale for Measuring Spasticity and Modified Ashworth Scale (Not Recommended)
		Somatosensory Testing
			Quick Somatosensory Testing (Screening Test)
			Light Touch: Primary Sensation
				Location Test for Light Touch
				Ipswich Touch Test (Special Test)
				Tactile Thresholds Test for Light Touch (Special Test)
			Light Touch: Cortical Sensations (Special Tests)
				Two-Point Discrimination
				Bilateral Simultaneous Touch: Test for Sensory Extinction
				Graphesthesia
			Conscious Proprioception
				Joint Movement
				Joint Position
				Vibration
			Sharp Versus Dull Sensation: Pinprick Sensation (Screening Test)
				Sharp, Prickling Sensation
			Discriminative Temperature Sensation (Special Test)
			Brush Allodynia Test for Neuropathic Pain (Special Test)
		Coordination Testing
			Rapid Alternating Movements (Screening Test)
			Accuracy and Smoothness of Movements
				Finger-to-Nose Test (Screening Test)
				Finger-to-Finger Test
				Heel-to-Shin Test (Screening Test)
				Tandem Walking: Walking Heel-to-Toe
		Spinal Reflex Testing
			Tendon Reflex (Screening Test)
			Clonus (Special Test)
			Plantar Reflex (Screening Test)
		Postural Control Testing
			Romberg Test
			Tandem Romberg (Screening Test)
			Stability: Abnormal Involuntary Movements (Observation Is a Screening Test)
		Gait
			Walking
			Tandem Walking: Walking Heel-to-Toe
			Walking on Heels (Screening Test)
			Walking on Toes (Screening Test)
			Stops Walking When Talking
			Walking While Turning the Head Right and Left on Command or While Moving the Head Up and Down (Screening Test)
			Stopping Quickly on Command, Making a Quick Pivot Turn on Command, or Navigating an Obstacle Course
			Walking While Carrying a Cup of Water
		3 Appendix
		References
	4 Neuroimaging and Neuroanatomy Atlas
		Chapter Outline
		Chapter Objectives
		Computed Tomography
			Contrast-Enhanced Computed Tomography
		Magnetic Resonance Imaging
			T1- and T2-Weighted Magnetic Resonance Imaging
			Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging
			Diffusion Imaging
				Diffusion-Weighted Imaging
				Diffusion Tensor Imaging
			Contrast Magnetic Resonance Imaging
		Neuroangiography
		Functional Imaging Techniques
			Positron Emission Tomography
			Functional Magnetic Resonance Imaging
		Conclusion
		Neuroanatomy Imaging Atlas
		References
2 Neuroscience at the Cellular Level
	5 Physical and Electrical Properties of Cells in the Nervous System
		Chapter Outline
		Chapter Objectives
		Introduction
		Structure of Neurons
			Components of Neurons
			Axoplasmic Transport
			Types of Neurons
				Bipolar Cells
				Multipolar Cells
		Propagation of Information by Neurons
			Membrane Channels
			Electrical Potentials
		Resting Membrane Potential
		Changes From Resting Membrane Potential
			Local Potentials and Action Potentials
				Local Potentials
				Action Potentials
					Propagation of Action Potentials
					Myelination
					Saltatory Conduction
		Direction of Information Flow in Neurons
		Interactions Between Neurons
		Glia: Signaling and Supporting Cells
			Myelinating: Oligodendrocytes and Schwann Cells
			Signaling/Cleaning/Nourishing: Astrocytes
			Defending: Microglial Cells
		Neuroinflammation: Beneficial and Harmful Effects
		Myelin: Clinical Application
			Peripheral Nervous System Demyelination
			Central Nervous System Demyelination
		Neural Stem Cells
		Summary
		References
	6 Neural Communication
		Chapter Outline
		Chapter Objectives
		Structure of the Synapse
		Events at the Synapse
		Electrical Potentials at Synapses
			Postsynaptic Potentials
				Excitatory Postsynaptic Potential
				Inhibitory Postsynaptic Potential
			Presynaptic Facilitation and Inhibition
		Neuromessengers: Neurotransmitters and Neuromodulators
		Synaptic Receptors
			Ligand-Gated Ion Channels
			G-Protein Activation of Ion Channels
		Extrasynaptic Receptors
			Cascade of Intracellular Events: G-Protein Second-Messenger System
		Neuromessenger Agonists and Antagonists
		Specific Neurotransmitters and Neuromodulators
			Acetylcholine
			Amino Acids
				Glutamate
				Glycine and γ-Aminobutyric Acid
			Amines
				Dopamine
				Norepinephrine
				Serotonin
				Histamine
			Peptides
				Opioid Peptides
				Substance P
				Calcitonin Gene-Related Peptide
			Nitric Oxide
		Receptor Regulation
		Disorders of Synaptic Function
			Diseases Affecting the Neuromuscular Junction
			Channelopathy
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	7 Neuroplasticity
		Chapter Outline
		Chapter Objectives
		Habituation
		Experience-Dependent Plasticity: Learning and Memory
			Long-Term Potentiation and Depression
			Transcranial Magnetic Stimulation
			Astrocytes Contribute to Experience-Dependent Plasticity
		Metabolic Effects of Brain Injury
		Axonal Injury
			Axonal Injury in the Periphery
			Axonal Injury in the Central Nervous System
		Cellular Recovery From Injury
			Synaptic Changes Following Injury
			Functional Reorganization of the Cerebral Cortex
			Activity-Related Changes in Neurotransmitter Release
			Neurogenesis
		Effects of Rehabilitation on Plasticity
			Early Rehabilitation
			Specific Types of Rehabilitation Are Effective During the Chronic Phase Post Stroke
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
3 Development of the Nervous System
	8 Development of the Nervous System
		Chapter Outline
		Chapter Objectives
		Developmental Stages in Utero
			Pre-Embryonic Stage
			Embryonic Stage
			Fetal Stage
		Formation of the Nervous System
			Formation of the Neural Tube (Days 18 to 26)
			Relationship of the Neural Tube to Other Developing Structures
			Brain Formation (Begins Day 28)
			Continued Development During Fetal Stage
		Cellular-Level Development
		Nervous System Changes During Infancy
			Critical Periods
			Changes in Neck and Vestibular Reflexes
		Developmental Disorders: In Utero and Perinatal Damage to the Nervous System
			Neural Tube Defects
			Tethered Spinal Cord
			Spinal Muscular Atrophy
			Exposure to Alcohol or Cocaine in Utero
			Abnormal Locations of Cells
			Intellectual Disability
			Cerebral Palsy
			Developmental Coordination Disorder
			Attention Deficit Hyperactivity Disorder
			Autism Spectrum Disorders
			Summary of Developmental Disorders
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
4 Vertical Systems
	9 Autonomic Nervous System
		Chapter Outline
		Chapter Objectives
		Receptors
		Afferent Pathways
		Central Regulation of Visceral Function
			Control of Autonomic Functions by the Medulla and Pons
			Role of the Hypothalamus, Thalamus, and Emotion/Motivation System in Autonomic Regulation
			Integration of Information
		Efferent Pathways
			Differences Between the Somatic Motor System and the Autonomic Efferent System
			Neurotransmitters Used by the Autonomic Efferent System
				Cholinergic Neurons and Receptors
				Adrenergic Neurons and Receptors
		Sympathetic Nervous System
			Sympathetic Efferent Neurons
				Sympathetic Efferents to the Adrenal Medulla
				Sympathetic Efferents to the Periphery and Thoracic Viscera
				Sympathetic Efferents to Abdominal and Pelvic Organs
			Functions of the Sympathetic Nervous System
				Regulation of Body Temperature
				Regulation of Blood Flow in Skeletal Muscle
				Sympathetic Control in the Head
				Regulation of the Viscera
				Metabolism
		Parasympathetic Nervous System
		Comparison of Sympathetic and Parasympathetic Functions
		Clinical Correlations
			Horner’s Syndrome
			Peripheral Region
			Spinal Region
			Brainstem Region
			Cerebral Region
			Orthostatic Hypotension
			Syncope
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	10 Peripheral Somatosensory System
		Chapter Outline
		Chapter Objectives
		Sensory Receptors
		Somatosensory First-Order Neurons
		Cutaneous Innervation
			Peripheral Versus Dermatome Innervation
		Musculoskeletal Innervation
			Muscle Spindle
				Intrafusal and Extrafusal Fibers
			Golgi Tendon Organs
			Joint Receptors
		Function of Different-Diameter Axons
		Clinical Application
			Peripheral Nerve Lesions
			Proprioceptive Pathway Lesions: Sensory Ataxia
			Sensory Nerve Conduction Studies
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	11 Central Somatosensory System
		Chapter Outline
		Chapter Objectives
		Functions of Somatosensation
		Contribution of Somatosensory Information to Movement
		Somatosensory Information Protects Against Injury
		Pathways to the Brain
		Conscious Relay Pathways to Cerebral Cortex
			Light Touch and Conscious Proprioception: Dorsal Column/Medial Lemniscus Pathway
				Somatosensory Areas of the Cerebral Cortex
				Somatotopic Arrangement of Information
			Nociception, Temperature, and Crude Touch: Anterolateral Columns
				Fast Versus Slow Nociception
			Discriminative (Fast) Nociception and Temperature and Crude Touch: Spinothalamic Pathway
				First-Order Neurons in the Spinothalamic Pathway
				Second-Order and Third-Order Neurons in the Spinothalamic Pathway
				Fast Nociceptive System: Lateral Nociceptive System
		Comparison of Dorsal Column/Medial Lemniscus and Spinothalamic Pathways
		Divergent Pathways With Projection Neurons in the Anterolateral Columns: Slow Nociception, the Medial Nociception System
			First-Order Neuron
			Ascending Projection Neurons
				Spinomesencephalic Tract
				Spinoreticular Tract
				Spino-emotional Tract
			Subconscious Temperature Information
		Nonconscious Relay Tracts to the Cerebellum: Spinocerebellar Tracts
		Summary of the Somatosensory System
		Somatosensory System Lesions
			Infection: Varicella Zoster (Shingles)
		Somatosensory Evoked Potentials
		Clinical Perspectives on Pain
			Pain From Muscles and Joints
			Referred Pain
			The Pain Matrix
			How Is Pain Controlled?
				Counterirritant Theory
				Dorsal Horn Processing of Nociceptive Information
				Antinociceptive Systems
				Sites of Antinociception
				Pronociception: Biologic Amplification of Nociception
		Chronic Pain
			Nociceptive Chronic Pain
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	12 Pain as a Disease
		Chapter Outline
		Chapter Objectives
		Chronic Pain as a Disease
		Neuropathic Pain
			Symptoms of Neuropathic Pain
			Four Mechanisms Produce Neuropathic Pain
				Ectopic Foci
				Ephaptic Transmission
				Central Sensitization
				Structural Reorganization
			Sites That Generate Neuropathic Pain
				Peripheral Generation of Neuropathic Pain
				Central Response to Deafferentation
					Phantom Pain
					Central Pain: Spinal Cord Injury, Stroke, and Multiple Sclerosis
					Small Fiber Neuropathy: Postherpetic Neuralgia, Diabetic Neuropathy, and Guillain-Barré Syndrome
		Central Sensitivity Syndromes
			Fibromyalgia
			Episodic Tension-Type Headache
			Migraine
			Red Flags for Headache
			Chronic Whiplash-Associated Disorder
		Pain Syndromes
			Complex Regional Pain Syndrome
			Chronic Low Back Pain Syndrome
		Medications for Neuropathic Pain, Fibromyalgia, and Chronic Low Back Pain Syndrome
		Surgical Treatment of Chronic Pain
		Psychologic Factors in Chronic Pain
		Conflicts Between Patient and Provider Goals
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	13 Motor System
		Chapter Outline
		Chapter Objectives
		The Motor System
		Skeletal Muscle Structure and Function
			Contraction
			Total Muscle Resistance to Stretch
			Muscle Tone: Resistance to Passive Stretch
			Number of Sarcomeres Adapts to Muscle Length
			Joint Resistance to Movement and Cocontraction
		Motor Neurons
			Motor Neuron Cell Body Pools in the Spinal Cord
			Myotomes
			Alpha and Gamma Motor Neurons
				Alpha-Gamma Coactivation
			Motor Units
		Spinal Region Motor Function
			Spinal Cord Coordination
				Reciprocal Inhibition
				Muscle Synergies
				Proprioceptive Body Schema
				Role of Golgi Tendon Organs in Movement
				Spinal Control of Walking: Stepping Pattern Generators
			Spinal Reflexes
				Phasic Stretch Reflex: Muscle Spindles
				Cutaneous Reflex: Withdrawal Reflex
			Relationship Between Reflexive and Voluntary Movement
		Involuntary Muscle Contractions
			Fibrillations
			Tremors
		Signs of Motor Neuron Lesions
			Decrease or Loss of Reflexes
			Paresis and Paralysis
			Muscle Atrophy
			Abnormal Muscle Tone
		Electrodiagnostic Studies
			Motor Nerve Conduction Studies
			Electromyography
				Muscle Activity at Rest
				Electromyographic Signs of Denervated and Reinnervated Muscle Versus Myopathy
		Disorders of Motor Neurons
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	14 Motor System
		Chapter Outline
		Chapter Objectives
		Sensory Contribution to Movement Control
		Movement Strategies
		The Central Motor System
		Motor Tracts to the Spinal Cord
			Postural and Gross Movements: Medial Motor Tracts
				Reticulospinal Tract
				Medial Vestibulospinal Tract
				Lateral Vestibulospinal Tract
				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.
			Fractionated Movements and Distal Limb Movements: Lateral Motor Tracts
				Rubrospinal Tract
				Lateral Corticospinal Tract
			Nonspecific Motor Tracts
			Control of Muscles in the Head and the Superficial Neck Muscles: Corticobrainstem Tracts
			Cortical Motor Areas
		Signs of Motor Tract Lesions
			Paresis and Paralysis
			Abnormal Reflexes
				Abnormal Cutaneous Reflexes
				Phasic Stretch Hyperreflexia
				Tonic Stretch Reflex
				Clonus
				Clasp-Knife Response
			Myoplasticity
				Muscle Disuse Atrophy
			Abnormal Muscle Tone
				Flaccidity and Hypotonicity
				Temporary Hypotonia Owing to Central Nervous System Shock
				Hypertonia
					Spasticity: Velocity-Dependent Hypertonia
					Rigidity
			Loss of Fractionation of Movement
			Abnormal Cocontraction
			Abnormal Muscle Synergies
		Mechanism of Functional Limitations Depends Upon Site of Lesion and Whether Lesion Occurs Perinatally
			Spastic Cerebral Palsy: Abnormal Cocontraction, Hyperreflexia, Brainstem Motor Tract Overactivity, and Myoplastic Changes
			Primary Motor Control Problem in Adult-Onset Motor Tract Syndromes: Paresis and/or Paralysis
			Middle Cerebral Artery Stroke: Paresis/Paralysis, Loss of Fractionation, Reticulospinal Overactivity, and Myoplastic Changes
				Paresis and Voluntary Movement Post Stroke
				Reticulospinal Tract Overactivity
				Myoplastic Changes Post Stroke
				Ipsilateral Upper Limb Impairment Post Stroke
			Spinal Motor Tract Lesions: Paresis, Paralysis, and Hyperreflexia
				Hyperreflexia in Spinal Cord Injury
				Contracture
		Surface Electromyography Differentiates Some Impairments Secondary to Motor Tract Lesions
		Motor Tract Lesions: Common Characteristics and Differences
		Interventions for Impairments Secondary to Motor Tract Lesions
			Spastic Cerebral Palsy
			Stroke
			Spinal Cord Injury
			Medications for Spasticity
			Stretching Is Ineffective for Contracture Treatment in People With Neurologic Conditions
		Amyotrophic Lateral Sclerosis
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	15 Motor System
		Chapter Outline
		Chapter Objectives
		Introduction to the Cerebellum
			Cellular Anatomy of the Cerebellar Cortex
			Gross Anatomy of the Cerebellum
				Cerebellar Lobes
				Cerebellar Peduncles
		Functional Regions of the Cerebellum
			Vestibulocerebellum
			Spinocerebellum
				Spinocerebellar Pathways and Tracts
				High-Fidelity Pathways
					Posterior Spinocerebellar Pathway
					Cuneocerebellar Pathway
				Internal Feedback Tracts
					Anterior Spinocerebellar Tract
					Rostrospinocerebellar Tract
				Spinocerebellar Output
			Cerebrocerebellum
				Nonessential Cognitive Functions of the Cerebrocerebellum
		Signs of Cerebellar Dysfunction
			Differentiating Cerebellar From Somatosensory Ataxia
		Disorders That Affect the Cerebellum
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	16 Motor and Psychologic Functions
		Chapter Outline
		Chapter Objectives
		Anatomic Orientation to the Basal Ganglia
		Neurotransmitters and the Basal Ganglia
		Basal Ganglia Circuitry
			Goal-Directed Behavior Loop
			Social Behavior Loop
			Emotion Loop
			Oculomotor Loop
			Motor Loop
				Hyperdirect, Go, and No-Go Pathways
					Hyperdirect Pathway
					Go Pathway
					No-Go Pathway
		Basal Ganglia Motor Control
			Effect of Dopamine on the Go and No-Go Pathways
			Basal Ganglia Regulation of the Motor Thalamus, the Pedunculopontine Nucleus, and the Midbrain Locomotor Region
		Basal Ganglia Disorders
			Hypokinetic Disorders
				Parkinson’s Disease
					Postural Instability Gait Difficulty Subtype of Parkinson’s Disease
					Tremor-Dominant Parkinson’s Disease
					Pathology in Parkinson’s Disease
					Treatments for Parkinson’s Disease
				Parkinson-Plus Syndromes
				Parkinsonism
			Hyperkinetic Disorders
				Huntington’s Disease
				Dystonia
				Tourette’s Disorder
				Dyskinetic Cerebral Palsy
		Summary of the Basal Ganglia
		Movement
			Feedforward and Feedback
			Three Fundamental Types of Movements
				Postural Control
				Ambulation
				Reaching and Grasping
		Summary of Normal Motor Control
		Advanced Diagnostic Clinical Reasoning
		References
5 Regions
	17 Peripheral Region
		Chapter Outline
		Chapter Objectives
		Peripheral Nerves
			Nerve Plexuses
			Movement Is Essential for Nerve Health
		Neuromuscular Junction
		Dysfunction of Peripheral Nerves
			Sensory Changes
			Autonomic Changes
			Motor Changes
			Denervation: Trophic Changes
		Classification of Neuropathies
			Traumatic Injury to a Peripheral Nerve: Mononeuropathy
				Traumatic Myelinopathy
				Traumatic Axonopathy
				Severance
			Multiple Mononeuropathy
			Polyneuropathy
				Diabetic Polyneuropathy
				Idiopathic Polyneuropathy
				Guillain-Barré Syndrome
				Hereditary Motor and Sensory Neuropathy (Charcot-Marie-Tooth Disease)
		Dysfunctions of the Neuromuscular Junction
		Myopathy
		Electrodiagnostic Studies
		Clinical Testing
		Evaluation and Intervention
			Evaluation
			Interventions for Peripheral Neuropathy
		Summary
		Advanced Diagnostic Clinical Reasoning
		Appendix 17.1 Distribution of Nerves in the Upper Limbs
		Appendix 17.2 Distribution of Nerves in the Lower Limbs
		References
	18 Spinal Region
		Chapter Outline
		Chapter Objectives
		Anatomy of the Spinal Region
			Ventral and Dorsal Roots
			Segments of the Spinal Cord
			Spinal Nerves and Rami
			Internal Structure of the Spinal Cord
			Meninges
			Blood Supply
		Movements of the Spinal Cord and Roots Within the Vertebral Column
		Functions of the Spinal Cord
			Classification of Spinal Interneurons
		Spinal Cord Motor Coordination
			Stepping Pattern Generators
			Reflexes
			Inhibitory Circuits
				Reciprocal Inhibition
				Recurrent Inhibition
		Spinal Control of Pelvic Organ Function
		Effects of Segmental and Tract Lesions in the Spinal Region
			Signs of Segmental Dysfunction
			Signs of Vertical Tract Dysfunction
			Segmental and Vertical Tract Dysfunction
		Differentiating Spinal Region From Peripheral Region Lesions
		Spinal Region Syndromes
		Effects of Spinal Region Dysfunction on Pelvic Organ Function
		Traumatic Spinal Cord Injury
			Abnormal Interneuron Activity in Chronic Spinal Cord Injury
			Classification of Spinal Cord Injuries
			Determination of Neurologic Levels
			Autonomic Dysfunction in Spinal Cord Injury
				Autonomic Dysreflexia
				Poor Thermoregulation
				Orthostatic Hypotension
			Prognosis and Treatment in Spinal Cord Injury
		Specific Disorders Affecting Spinal Region Function
			Myelomeningocele
			Spastic Cerebral Palsy
			Lesions of Dorsal and Ventral Nerve Roots
			Lesions of Dorsal Root Ganglia
			Multiple Sclerosis
			Transverse Myelitis
			Compression in the Spinal Region
				Spinal Region Tumors
				Vertebral Canal Stenosis
					Cervical Stenosis
					Lumbar Stenosis
				Syringomyelia
		Red Flags for the Spinal Region
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	19 Cranial Nerves
		Chapter Outline
		Chapter Objectives
		Cranial Nerve 1: Olfactory
		Cranial Nerves 2 to 4 and 6: Optic, Oculomotor, Trochlear, and AbducensaCovered in depth in Chapter 21.
		Cranial Nerve 5: Trigeminal
		Cranial Nerve 7: Facial
		Cranial Nerve 8: VestibulocochlearbVestibular nerve function is covered in depth in Chapter 22.
			Cochlea
				Converting Sound to Neural Signals
			Auditory Function Within the Central Nervous System
		Cranial Nerve 9: Glossopharyngeal
		Cranial Nerve 10: Vagus
		Cranial Nerve 11: Accessory
		Cranial Nerve 12: Hypoglossal
		Cranial Nerves Involved in Swallowing and Speaking
			Swallowing
			Speaking
		Systems Controlling Cranial Nerve Motor Neurons
			Descending Control of Motor Cranial Nerves
				Voluntary Control of Cranial Nerve Motor Neurons: Corticobrainstem Tracts
				Voluntary Versus Emotional Control of Cranial Nerve Motor Neurons
		Disorders Affecting Cranial Nerve Function
			Olfactory Nerve
			Trigeminal Nerve
				Trigeminal Neuralgia
			Facial Nerve
				Facial Nerve Versus Corticobrainstem Tract Lesions
				Bell’s Palsy
				Ramsay Hunt Syndrome
			Vestibulocochlear Nerve and Disorders of the Auditory System
			Glossopharyngeal Nerve
			Vagus Nerve
			Accessory Nerve
			Hypoglossal Nerve
			Dysphagia
			Dysarthria
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	20 Brainstem Region
		Chapter Outline
		Chapter Objectives
		Anatomy of the Brainstem
			Vertical Tracts in the Brainstem
			Longitudinal Sections of the Brainstem
		Reticular Formation
		Reticular Nuclei and Their Neurotransmitters/Neuromodulators
			Ventral Tegmental Area: Dopamine
			Pedunculopontine Nucleus: Acetylcholine
			Raphe Nuclei: Serotonin
			Locus Coeruleus and Medial Reticular Zone: Norepinephrine
			Regulation of Consciousness by the Ascending Reticular Activating System
		Medulla
			External Anatomy of the Medulla
			Inferior Medulla
			Upper Medulla
			Functions of the Medulla
		Pons
		Midbrain
			Basis Pedunculi
			Midbrain Tegmentum
			Midbrain Tectum
		Cerebellum
		Arterial Supply to the Brainstem and Cerebellum
		Brainstem Rule of Four: Method for Recalling Brainstem Anatomy and Arterial Supply
		Disorders in the Brainstem Region
			Vertical Tract Signs
				Corticobrainstem Tract Lesions
			Contralateral and Ipsilateral Signs
			Disorders of Vital Functions
			Four Ds of Brainstem Region Dysfunction
			Disorders of Consciousness
			Tumors in the Brainstem Region
			Brainstem Region Ischemia
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	21 Visual System
		Chapter Outline
		Chapter Objectives
		Visual System
			Sight: Information Conveyed From Retina to Cortex
				First Neuron: From Retina Through Optic Nerve, Chiasm, and Tract to the Lateral Geniculate Nucleus
				Second Neuron: Lateral Geniculate Body to Primary Visual Cortex
				Cortical Destination of Visual Information
			Processing of Visual Information
			Disorders of the Visual System
				Optic Nerve Lesions
				Visual Field Deficits
				Cortical Blindness and Blindsight
		Cranial Nerve 3: Oculomotor Parasympathetic Efferents for the Pupillary Light Reflex and the Near Triad
			The Pupillary Light Reflex
			The Near Triad
		Cranial Nerves 3, 4, and 6: Oculomotor, Trochlear, and Abducens: Control of Eye Movements
			Extraocular Muscles
		Coordination of Eye Movements: Medial Longitudinal Fasciculus
		Disorders Affecting Cranial Nerves 3, 4, and 6 or the Medial Longitudinal Fasciculus
			Oculomotor Nerve
			Trochlear Nerve
			Abducens Nerve
			Medial Longitudinal Fasciculus
		The Eye Movement System
			Types of Eye Movements
			Gaze Stabilization: Vestibulo-ocular Reflexes, Optokinetic Nystagmus, Physiologic Versus Pathologic Nystagmus
				Vestibulo-ocular Reflexes
				Optokinetic Nystagmus
				Physiologic Versus Pathologic Nystagmus
			Direction of Gaze: Saccades, Smooth Pursuits, and Convergence
				Saccades
				Smooth Pursuit Eye Movements
				Convergence Eye Movements
			Disorders of the Eye Movement System
		Motion Sickness
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	22 Vestibular System
		Chapter Outline
		Chapter Objectives
		Peripheral Vestibular System
			Vestibular Apparatus
				Semicircular Canals
				Otolithic Organs
			Vestibular Nerve
		Signs and Symptoms of Vestibular Disorders
		Peripheral Vestibular Disorders
			Benign Paroxysmal Positional Vertigo: Canalithiasis
			Atypical Benign Paroxysmal Positional Vertigo: Cupulolithiasis
			Vestibular Neuritis
			Ménière’s Disease
			Traumatic Injury
			Perilymph Fistula
			Bilateral Lesions of the Vestibular Nerve
		Central Vestibular System
		Vestibular Role in Motor Control
		Perception: Inhibitory Visual-Vestibular Interaction in the Cerebral Cortex
		Central Vestibular Disorders
			Lesions of the Vestibulothalamocortical Pathway or Vestibular Cortex
			Vestibular Migraine
			Persistent Postural-Perceptual Dizziness
		Unilateral Vestibular Loss
		Bilateral Vestibular Loss
		Evaluating the Vestibular System
			Differentiating Vestibular, Cerebellar, and Sensory Ataxia: Lower Limb Coordination Tests
			Sensory Testing
			Specialty Clinic Testing of Vestibulo-Ocular Reflexes
		Rehabilitation in Vestibular Disorders
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	23 Dizziness and Unsteadiness
		Chapter Outline
		Chapter Objectives
		Introduction
		Traditional Versus Evidence-Based Approach to Dizziness and Unsteadiness
		General Approach to Differential Diagnosis of Dizziness
			Timing
			Triggers
			Oculomotor Signs
			Provocative Tests for Specific Indications
			Other Targeted Tests
		Frequency of Specific Causes of Dizziness/Unsteadiness
		The Diagnostic Process: How to Use the Appendices
		Appendix A How to Categorize Acute Onset Dizziness
		Appendix A1 Differential Diagnosis: Acute Onset Triggered Episodic Dizziness
		Appendix A2 Differential Diagnosis: Acute Onset Spontaneous Episodic Dizziness
		Appendix A3 Differential Diagnosis: Acute Onset Spontaneous Continuous Dizziness
		Appendix A4 Differential Diagnosis: Acute Onset Traumatic/Toxic Continuous Dizziness
			Screening Questions for Traumatic/Toxic Dizziness
			Traumatic Dizziness
			Dizziness Caused by Toxins
		Appendix B How to Categorize Chronic Duration Dizziness and Unsteadiness
		Appendix B1 Differential Diagnosis: Triggered Chronic Dizziness and Unsteadiness
		Appendix B2 Differential Diagnosis: Spontaneous Chronic Dizziness and Unsteadiness
		References
	24 Cerebrospinal Fluid System
		Chapter Outline
		Chapter Objectives
		Cerebrospinal Fluid System
			Ventricles
			Meninges
			Formation and Circulation of Cerebrospinal Fluid
		Clinical Disorders of the Cerebrospinal Fluid System
			Epidural and Subdural Hematomas
			Hydrocephalus
			Meningitis
		Craniosacral Therapy
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	25 Blood Supply, Stroke, Fluid Dynamics, and Intracranial Pressure
		Chapter Outline
		Chapter Objectives
		Disorders of Vascular Supply
		Types of Stroke
			Brain Infarction
			Hemorrhage
				Subarachnoid Hemorrhage
		Stroke Signs and Symptoms by Arterial Location
			Vertebral and Basilar Artery Stroke (see Fig. 25.2)
			Cerebral Artery Stroke (see Figs. 25.2A and 25.3)
				Anterior Cerebral Artery
				Middle Cerebral Artery
				Posterior Cerebral Artery
				Watershed Area
		Disorders of Vascular Formation
			Arteriovenous Malformations
			Aneurysm
		Fluid Dynamics
			Blood-Brain Barrier
			Cerebral Blood Flow
			Cerebral Edema
		Intracranial Pressure
		Brain Herniations (Fig. 25.13)
			Cingulate Herniation
			Uncal Herniation
			Central Herniation
			Tonsillar Herniation
		Review of Evaluation of Cerebral Blood Flow
		Venous System
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	26 Cerebrum
		Chapter Outline
		Chapter Objectives
		Introduction
		Diencephalon
			Thalamus
				Thalamic Lesions
				Lateropulsion: Lesion of the Posterior Thalamus or Vestibular Nuclei
			Hypothalamus
				Hypothalamus and Pituitary Gland
					Hormones Released From the Anterior Pituitary Gland
					Neurohormones Released From the Posterior Pituitary Gland
				Pituitary Tumors
			Epithalamus
			Subthalamus
		Subcortical Structures
			Subcortical White Matter
				Projection Fibers: Internal Capsule
				Commissural Fibers
				Association Fibers
			Subcortical White Matter Lesions
				Internal Capsule
				Callosotomy
			Basal Ganglia
		Cerebral Cortex
			Mapping of the Cerebral Cortex
			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.
		Primary Sensory Areas of the Cerebral Cortex
			Primary Somatosensory Cortex
			Primary Auditory and Primary Vestibular Cortices
			Primary Visual Cortex
			Primary Sensory Area Lesions: Loss of Discriminative Sensory Information
		Perception
		Secondary Sensory Areas
			Use of Visual Information: Action and Perceptual Streams
			Lesions Affecting Secondary Sensory Areas: Agnosia
				Astereognosis
				Visual Agnosia: Lesion in the Ventral Visual Stream
				Auditory Agnosia
			Optic Ataxia: Lesion in the Dorsal Visual Stream
		Primary Motor Cortex
			Primary Motor Cortex Lesions: Loss of Movement Fractionation and Dysarthria
			Alien Hand Syndrome: Isolated Activation of the Primary Motor Cortex
		Cortical Motor Planning Areas
			Connections of the Motor Areas
			Motor Planning Area Disorders: Apraxia, Motor Perseveration, Broca’s Aphasia, and Impaired Nonverbal Communication
		Association Areas of the Cerebral Cortex
		Diseases That Affect a Variety of Cerebral Structures
			Cerebral Stroke
				Signs and Symptoms of Stroke
				Recovery From Stroke
			Tumors
			Epilepsy
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	27 Memory, Consciousness, and Intellect
		Chapter Outline
		Chapter Objectives
		Memory
			Working Memory
			Declarative Memory
				Episodic Versus Semantic Declarative Memory
				Declarative Memory Failure: Amnesia
			Procedural Memory
		Consciousness
			Limits of Attention
			Disorders Affecting the Consciousness System
				Loss of Consciousness
				Impaired Attention
				Attention Deficit Hyperactivity Disorder
		Intellect
			Disorders of Intellect
				Trisomy 21
				Phenylketonuria
				Learning Disabilities
		Dementia
			Alzheimer’s Disease
			Frontotemporal Dementia
			Dementia in Parkinson’s, Parkinson-Plus Syndromes, and Chronic Traumatic Encephalopathy
		Summary
		Advanced Diagnostic Clinical Reasoning
		References
	28 Behavior, Emotions, Decision Making, Personality
		Chapter Outline
		Chapter Objectives
		Introduction
		Association Areas of the Cerebral Cortex
		Goal-Directed Behavior and Divergent Thinking
			Lateral Prefrontal Cortex and the Goal-Directed Behavior Loop
				Lateral Prefrontal Cortex Lesions: Loss of Goal-Directed Behavior and Divergent Thinking
		Emotions, Self-Awareness, and Motivation
			Medial Prefrontal Association Cortex
				Medial Prefrontal Association Cortex Lesions: Apathy, Lack of Emotions and Insight
			Identifying Emotional Stimuli, Generating and Perceiving Emotions
				The Emotion Loop
			Regulating Emotions
				Emotional Lability
			Motivation
				Ventral Striatum Disorders
				Motivation: The Reward-Seeking Pathway and Addiction
				Motivation: The Avoidance-Seeking Pathway
		Social Behavior
			The Ventral Prefrontal Cortex and the Social Behavior Loop
			Social Decision Making and the Somatic Marker Hypothesis
				Ventral Prefrontal Cortex Lesions: Inappropriate Social Behavior
		Personality Characteristics
		Psychologic and Somatic Interactions
		Neurologic/Psychiatric Signs and Symptoms
		Psychiatric Disorders
			Personality Disorders
			Anxiety Disorders
			Depression
			Somatic Symptom Disorder: Misattributed Causation
			Autism Spectrum Disorders
			Bipolar Disorder
			Schizophrenia
		Traumatic Brain Injury
		Summary
		References
	29 Communication, Directing Attention, and Spatial Cognition
		Chapter Outline
		Chapter Objectives
		Introduction
		Communication
			Language
				Language Disorders
			Nonverbal Communication
				Disorders of Nonverbal Communication
		Directing Attention
		Spatial Perception
		Neglect
			Personal Neglect
			Spatial Neglect
			Frequency of Neglect and Clinical Importance
		Hemispheric Specialization
		Summary of Cerebral Hemisphere Function
		Advanced Diagnostic Clinical Reasoning
		References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	Z