INTRO TO PT:
<3
WHAT IS PHYSICAL THERAPY AND HOW DID IT
START?
APTA DEFINITION
 Physical therapists are movement
experts who improve quality of life
through prescribed exercise, hands-on
care, and patient education
 Physical therapists are the experts in
diagnosis and treatment of human
movement
 Movement experts best able to design
safe and effective ways to develop,
improve, and maintain physical health for
people with or at risk for neurological
conditions (and other conditions)
PPTA DESCRIPTION
 Provides services to individuals and
populations to develop maintain and
restore maximum movement and
functional ability throughout the
lifespan (treat people of all ages)
 Concerned with identifying and
maximizing quality of life and
movement potential within the spheres
of promotion, prevention,
treatment/intervention, habilitation, and
rehabilitation
 Encompasses physical, psychological,
emotional, and social well being
 Involves the interaction between
physical therapist, patients/clients, other
health professionals, families, care givers,
and communities. (Involves a community)
Patients – are really sick
Clients – healthy individuals
- movement experts
- diagnose and treat human movement
problems
- by giving physical therapy inventions
- to achieve highest quality of life
- to all people of all ages
PHYSICAL THERAPISTS ARE QUALIFIED AND
PROFESSIONALLY REQUIRED TO:
 Undertake a comprehensive
examination/assessment/evaluation of
a patient/client or needs of a client group
(group of people/entire community)
Example: call center (help provide better posture
for employees)
 Formulate a diagnosis, prognosis, and
plan
PT Diagnosis – identifying a condition/putting a
label on the condition (movement diagnosis-
label on which movement impairment)
PT Prognosis – as a PT how do u see the patient’s
future during the rehabilitation
Example: a person who has a fractured hip and
he wants to play basketball after a week;
prognosis = bad prognosis to play basketball after
a week
PT Plan – treatment given
 Provide consultation within their
expertise and determine when
patients/clients need to be referred to
another healthcare professional
Consultations – we can do check ups
Referral - If this problem is within or beyond our
capacity as PT
PT can detect early conditions
 Implement a physical therapist
intervention/treatment program
 Determine the outcomes of any
interventions/treatments
 Make recommendations for self
Once discharged, give recommendations to
maintain/improve movement
management
VISION STATEMENT FOR PHYSICAL THRAPY
(APTA) VISION2020
 Physical therapy. By 2020, will be
provided by physical therapists who are
 INTRO TO PT:
<3
Doctors of Physical Therapy and who may
be board-certified
 Consumers will have direct access to
physical therapists in all environments for
patient/client management, prevention,
and wellness services.
 Physical therapists will be practitioners of
choice in patients’/clients’ health
networks and will hold all privileges of
autonomous practice (to be independent)
PHYSICAL THERAPIST ASSISTANT
 Provide physical therapist services under
the direction and supervision of a
physical therapist (can’t do this all alone,
need to have the go signal of your
supervisor PT)
 Have a BSPT Assistant and are licensed
(needs to pass board exam)
 Implement components of patient care,
obtain data related to the treatments
provided, and collaborate (make
suggestions) with the PT to modify care
as necessary (anything that does not
need clinical decision making, ex.
gathering data)
PTA goes to the patient and do the intervention.
They are the ones that always sees and is together
with the patient from beginning to end and reports
to the PT. Suggests to the PT and waits for the go
signal, The PT supervises and monitors
PHYSICAL THERAPIST AIDE
 Any support personnel (whatever
educational bg you have) who perform
designated tasks related to the operation
of the physical therapy services
 Does not need licensure exam
 Tasks are activities that do not required
the clinical decision making of the
physical therapist or the clinical problem
solving of the physical therapist assistant
 Do before and after care
NATURE OF PRACTICE OF PHYSICAL
THERAPY
 Professional scope – patient and client
management, which includes diagnosis
and prognosis, to optimize physical
function, movement, performance, health,
quality of life, and well-being across the
lifespan; includes contributions to public
health services
This is our role to the patient, not just individually
but to the community.
 Jurisdictional scope – established by the
practice act governing the specific
physical therapist’s license and the rules
adopted pursuant to that act
Duties towards the governing agency.
The people who give licensure exams to give us a
license
Example: PRC (Professional Regulating
Commission)
 Personal scope – activities for which an
individual physical therapist is educated,
trained, and is competent to perform (for
own self)
HISTORY OF PT IN THE US
 Two major historical events: The
poliomyelitis epidemics
(neuromusculoskeletal condition) of the
1800s through the 1950s and the effects
of the ravages of several wars
 Marguerite Sanderson & Mary
McMillan – first 2 individuals involved in
the training of “reconstruction aides”
responsible for caring for those
individuals wounded in World War I
 In the 1990s, the Americans with
Disabilities Act and the National
Center for Medical Rehabilitation
Research led to new opportunities for
 INTRO TO PT:
<3
practice. (Focused their work on
developing PT)
AMERICAN PHYSICAL THERAPY
ASSOCIATION (APTA)
 1921
 To serve those who sacrificed so much for
our country in World War I
HISTORICAL DEVELOPMENT OF PHYSICAL
THERAPY PROFESSION IN THE PHILIPPINES
 Department of Medicine of the Faculty of
Medicine and Surgery of the University
of Santo Tomas  Section of
Electrotherapeutics (1908-1909)
 August 1938  US Army physical
therapist  Sternberg General Hospital
in Manila
INTRO TO PT:
<3
 INTRO TO PT:
<3
THE BODY’S ORGANIZATION
CELLS: NATURE’S BUILDING BLOCKS
 Body’s basic building block and smallest
living component of an organism
 In the late 1600s, British physicist Robert
Hooke first observed plant cells
 The structures reminded him of tiny prison
cells
BODY TISSUES: HOLDING IT ALL TOGETHER
 Groups of similar cells that perform the same
role
 Each tissue has at least one unique function
 Four types: epithelial, connective, muscle and
nervous
Epithelial Tissue
 or epithelium is a continuous sheet that
covers the body’s surface, lines body cavities,
and forms glands
Connective Tissue
 four categories: fibrous, bone, cartilage, or
blood
 found in or around almost every organ of the
body
 to support, connect, and transport
Muscle Tissue
 Striated muscle tissue – striped or straited;
all that are capable of voluntary contractions
is called skeletal muscle tissue
 Cardiac muscle tissue – striated but
contracts involuntary
 Smooth muscle tissue – lacks the stripped
pattern; consists of long, spindle-shaped cells
Nervous Tissue
 Main function: communication
 Irritability (capacity to react to various
physical chemical agents)
 Conductivity (ability to transmit the resulting
reaction from one point to another
 May be neurons or neuroglia
 Neurons consist of dendrites, the cell body,
and axons
 Dendrites receive impulses and conduct
them into the cell body
 Axons carry impulses away from the cell
body
 Neuroglia insulating and protecting
neurons
 Only found in the central nervous system
ORGANS AND SYSTEMS: THE SPECIALIST
 Organs – when a group of tissues handle a
more complicated task than any one tissue
can do
 Systems – combination of organs, which
perform a more complex function than any
one organ can do on its own
THE INTEGUMENTARY SYSTEM
SKIN STRUCTURE AND FUNCITON
 Integumentary system – largest body
system that includes the skin and its
appendages (hair, nails, and certain glands)
 Integument -> integumentum -> covering
SKIN LAYERS
 Epidermis – outermost later
 Dermis – second layer; also called corium
PHYSICAL EXAMINATION TERMS
 The skin can provide useful information
about the body’s overall condition
SKIN COLOR
 Cyanosis – bluish skin color caused by an
excess of oxygen-starved hemoglobin
molecules in the blood
 Pallor – pale skin
 Ecchymosis – reddish purple skin
discoloration
 Erythema – redness or inflammation of skin
resulting from congestion of the superficial
capillaries
 INTRO TO PT:
 Purpura – purple-red or brown-red
discoloration on the skin due to hemorrhage
in the tissues
 Petechiae – small (pinpoint) discolored areas
 Jaundice – yellowing of skin
 Carotenemia – yellow-orange skin
discoloration
SKIN TURGOR
 TURGOR – condition of normal tension in
the skin and reflects the skin’s elasticity
LESIONS
 Abnormal changes in the skin
 Produced by allergens, weather, injury, and
various diseases
PRIMARY LESIONS
 Bulla – flat-fluid filled, blister or bleb
 Cyst – semisolid encapsulated mass that
extends deep into the dermis
 Macule – flat, pigmented area that’s less
than 3/8” in diameter
 Freckle – example of a macule
 Papule – firm, raised lesion up to ¼” in
diameter that may be skin color or
pigmented
 Plaque – flat, raised patch on the skin
 Tumor – elevated solid lesion larger than ¾”
that extends into the dermal and
subcutaneous layers
 Vesicle – raised, firm lesion less than ¼” in
diameter; chicken pox produces vesicles
 Wheal – raised, firm lesion with intense,
usually temporary, swelling around the area
 Urticaria/hivers – type of wheal
SECONDARY LESIONS
 Atrophy – thinning of the skin surface due
to disorder or aging
 Crust – dried exudate (drainage) covering an
eroded or weeping are of skin
 Erosion – caused by loss of epidermis
 Excoriation – linearly scratched/abraded
area
 Fissures – linear cracks in the skin that
extends into the dermal layer; chapped skin
causes fissures
 Keloid – hypertrophied scar
<3
 Lichenification – thick, roughened skin with
exaggerated skin lines
 Scales – thin, dry flakes of shedding skin
 Scars – fibrous tissue caused by trauma,
deep inflammation, or surgical incision
 Ulcer – epidermal and dermal destruction
that may extended into the subcutaneous
tissue
THE SKELETAL SYSTEM
AXIAL VS. APPENDICULAR SKELETON
AXIAL SKELETON
 Latin axis -> axle/wheel
 Forms the body’s vertical axis
 Includes bones of the skull, vertebral column,
and rib cage
APPENDICULAR SKELETON
 Latin appendare -> add or append
 Includes body’s appendages or upper and
lower extremities
THE AXIAL SKELETON
 Skull
- Cranium – Greek -> kranion -> upper part of head
- Face
 Spinal column
 Sutures – immobile(slightly) joints that hold
the skull bones together
 Sinuses – air-filled spaces within the skull
that lessen the bone weight, moisten
incoming air, and act as resonating chambers
for the voice
 Fontanel – fontanelle -> French for little
fountain; any membrane covered area
between two bones
 Orbits – eye sockets
THE SPINAL COLUMN
 Contains vertebra (plural: vertebra), sacrum,
and coccyx
 Spine – Latin spina -> thorn, related to spike
as well
 Vertebra – Latin ->to turn; formerly
connoted any joint, not just those of the
spine
 Spondylos – Greek -> the same meaning as
vertebra
 INTRO TO PT:
 Sacrum – formerly known as sacrum, the
holy bone; it was thought to be offered to
the gods in sacrifice
 Coccyx – Greek for cuckoo, kakkyx;
resembled the shape of bird’s bill
STERNUM
 Located in the center of the chest
 Flat, sword-shaped bone that’s attached to
the clavicles (collarbones) and the innermost
part of the first two pairs of ribs
THORACIC CAGE OR THORAX
 Flexible structure that protects the heart and
lungs and allow the lings to expand during
respiration
RIBS
 Flat, curved bones attached to the thoracic
portion of the spinal column
 Costal = ribs
 Costal cartilage – first 7 pairs of ribs are
attached to the sternum; called true ribs
<3
 False ribs – remaining 5 pairs of ribs; aren’t
attached directly to the sternum
APPENDICULAR SKELETON
 Includes upper and lower extremities
UPPER EXTREMITIES
 Clavicles – collarbones
 Scapulae – shoulder blades
 Humerus – upper arm bone; a long bond
with a shaft and two bulbous ends
 Ulna – one of the two long bones of the
lower arm; located in the little finger side
 Radius – one of the two long bones of the
lower arm; thumb side
 Metacarpal – form the palm of the hand
 Phalanges – finger bones
LOWER EXTREMITIES
 Contain bones of the hip, thigh, leg, ankle,
and foot
Pelvic girdle
 3 pairs of bones that fuse during childhood:
ilium, ischium, and pubis
 Broadest bone in the body
Ilium – largest and uppermost of the 3
Ischium – lower and strongest set of bones
 INTRO TO PT:
<3
Pubis – pair of bones in the front that meet at the  Cuneiforms (lateral, intermediate, and
symphysis pubis – a cartilaginous bone medial) – 3 wedged-shaped bones that form
the arch of the foot
 Cuboid bone – articulates in the front with
the metatarsal bones

Femur
 Upper leg bones
 Longest and heaviest bones in the body
Acetabulum – hip socket
Patella – kneecap  Metatarsal bones – form the foot and articulate
Tibia with the tarsal bone and phalanges

 Shinbone  Phalanges (toes) – similar to fingers, with 3

 Largest and strongest of the lower leg bones bones in each toe except the great toe (thumb)
which has only 2.
Fibula
 Connects with the tibia at its proximal and
distal ends

ANATOMY OF BONES: SHAPES

 Long bones – main bones of the limbs, except
the patella, and those of the wrists and ankles
 Short bones – bones of the wrists and ankles
 Flat bones – includes the sternum, scapulae, and
cranium, among others
 Irregular bones – includes vertebrae & hip bone
ANATOMY OF BONES: MATERIAL
 Compact bone – outer later; found in the
shaft of long bones & outer layers of short,
flat, and irregular bones
THE FOOT  Cancellous – porous bone; fills the central
 Tarsal bones – structurally resemble the wrist regions of the epiphysis and the inner
 Talus – astralagus; forms part of the ankle portions of short, flat, and irregular bones
joint
 Calcaneus – heel; largest tarsal bone Epiphysis – the end of a long bone where bone
formation takes place. (bulbous)
 Scaphoid bone - navicular because of its
boat shape
 INTRO TO PT:
LONG BONES
 Diaphyses (singular: diaphysis) – long,
narrow shaft of the bone contains the bone
marrow and has 2 irregular ends.
 Epiphyses (singular: epiphysis) – the bulbous
ends of long bones that provide a large
surface for muscle attachment and give
stability joints
 Articular cartilage – a thin layer of hyaline
cartilage that covers and cushions the
articular (joint) surface of the epiphysis
 Periosteum – a dense membrane that covers
the shafts of long bones; has 2 layers; fibrous
outer layer & a bone-forming inner layer
containing osteoblasts and osteoclasts.
 Medullar cavity – cavity filled with bone
marrow
 Endosteum – a thin membrane that lines the
medullary cavity and contains osteoblasts
and osteoclasts
Osteoblasts – bone producing cells
Osteoclasts – bone-destroying cells
FEEDING THE LONG BONES
 Within compact bone are haversian systems
 Lamellae – thin layers of ground substance
 Lacunae – small hollow spaces that contain
osteocytes
 Canaliculi – small canals
 Haversian canals – central canals that
contain blood & lymph vessels, nerves &
sometimes marrow
CARTILAGE
 Dense connective tissue and consists of
fibers embedded in a strong, gel-like
substance with shock absorption capabilities
 Unlike rigid bone, cartilages have the
flexibility of firm plastic
TYPES OF CARTILAGE
 Fibrous cartilage – forms at the meniscus
and the intervertebral disks
 Hyaline cartilage – covers articular bone
surfaces (where bones meet at a joint),
connects the ribs and sternum, and seen in
the trachea, bronchi, and nasal septum
<3
 Elastic cartilage – located in the auditory
canal, external ear, and epiglottis
JOINTS: TYPES IDENTIFIED BY THE RANGE
OF MOTION THEY ALLOW
 Synarthrosis – immovable
 Amphiarthrosis – slightly movable
 Diarthrosis – freely movable
JOINTS: ACCORDING TO WHAT IT’S MADE
OF
 Fibrous joints – the articular surfaces of the
two bones are bound closely by fibrous
connective tissue and little movement is
possible; example: cranial sutures
 Cartilaginous joints – cartilage connects
one bone to another; allow slight movement;
symphysis pubis
 Synovial joints – body surfaces here are
covered by articular cartilage and joined by
ligaments lined with synovial membrane;
Symphysis pubis – junction of the pelvic bones
Ligaments - dense, strong, flexible bands of
fibrous connective tissue that binds bones to
other bones
freely movable.
SYNOVIAL JOINTS CONTINUATION…
 Articular capsule – a saclike envelope,
whose outer layer is lined with a vascular
synovial membrane; contains synovial fluid
 Bursae (singular: Bursa) – synovial fluid sacs
located at friction points of all types of joints
as well as between tendons, ligaments, and
Synovial fluid – a viscid fluid, produced by the
synovial membrane that lubricates the joint
Vascular – presence of blood circulation
bones
 Gliding joints – allow adjacent bone surface
to move against on another
 Hinge joints – such as elbows and knees,
permit movement in only one direction
 Pivot joints (rotary joints/trochoid joints) –
such as neck and (proximal) elbows, allow
movable bone to pivot around a stationary
bone
 INTRO TO PT:
<3
 Condylar, or knuckle joints – contain an
oval head of one bone that fits into a shallow
depression in a second bone
 Saddle joints – resemble condylar joints but
allow greater freedom of movement;
carpometacarpal joints at the thumb
 Ball-and-socket joints (spheroid joints) –
get their name from how their bones
connect – the spherical head of one bone fits
into a socket of another bone
COMMON COMPLAINTS
 Arthralgia -pain in a joint
 Arthredema – joint swelling
 Arthropyosis – pus formation in a joint
cavity
 Bursitis – inflammation of a bursa
 Chondralgia – pain originating in the
cartilage
 Chondritis – inflammation of the cartilage
 Chondromalacia – abnormal softening of
the cartilage
 Coxitis – inflammation of the hip joint
 Epiphysitis – inflammation of the epiphysis
of a bone
 Hemarthrosis – blood in a joint cavity
 Hydrarthrosis – accumulation of watery fluid
in a joint cavity
 Kyphosis – Greek hunchback; abnormally
increased convexity in the curvature of the
thoracic spine
 Lordosis – forward curvature of the lumbar
spine
 Lumbago – pain in the lower back (lumbar)
region
 Ostealgia – bone pain
 Osteitis – inflammation of the bone
 Osteochondritis – inflammation of bone &
cartilage
 Osteolysis – degeneration of bone from
calcium loss
FRACTURES AND OTHER INJURIES
 Fractures – traumatic injuries or breaks in
bone tissue, most commonly occur in the
long bones of the arms and legs
 Pathologic failure – fracture that occurred
spontaneously when bone is weakened by
diseases
 Close fracture – broken bone doesn’t
protrude through skin
 Open fracture – bone breaks through skin,
causing tissue damage
OTHERS…
 Dislocation – displacement of a bone from
its normal position within the joint
 Subluxation – partial dislocation that
separates the joint’s movable surfaces,
occurs most commonly in the shoulder, hip,
and knee
 Herniated disk – a ruptured area in the
cartilage that cushions the intervertebral
disks of the spinal column, is painful
condition
 Bunions – localized areas of swelling that
occur on the foot near the joint of the big
toe, caused by inflammation and fibrosis of
the bursae
 Calluses – hard bone formations that may
occur at the site of bone fractures; also occur
due to thickening of the skin and often occur
on parts of the feet & fingers (KUBAL MAN
DIAY NI)
INVASIVE TREATMENTS OF JOINTS AND
BONES
 Arthrectomy – excision of joint
 Arthrodesis – a bone graft (usually from
patient’s iliac crest) used to fuse join surfaces
 Spondylosyndesis – applied to the
vertebrae
 Arthroplasty – surgically reconstructs joint
 Bone marrow transplant – involves I.V.
administration of marrow aspirated from the
donor’s bones to a recipient
 Chemonucleolysis – is when a drug is
injected into a herniated disk that dissolves
 INTRO TO PT:
<3
the nucleus pulposus, the pulpy, semifluid
center of the disk
 Costectomy – surgical excision of a rib
 Diskectomy – excision of an intervertebral
disk
 Hip replacement – when a diseased hip is
replaced with prosthesis (artificial substitute
for missing body parts)
 Laminectomy – surgical excision of the
lamina
 Laminotomy – excision of a bone or part of
a bone
 Ostectomy – excision of a bone or part of a
bone
 Osteotomy – incision or transection of a
bone
 Sternotomy – cut made through the
sternum
MUSCULAR SYSTEM
SKELETAL MUSCLES
 Are voluntary muscles that attach to the
skeleton
 Consist of striated tissue
 Move body parts and the body as a whole,
maintain posture, and implement voluntary
and reflex movements
 Also generate body heat
VISCERAL MUSCLES
 Involuntary muscles that contain smooth-
muscle tissue
 Found in such organs as the stomach and
intestines
CARDIAC MUSCLES (HEART)
 Made up of involuntary, striated tissue
 Controlled by the automatic nervous system
and specialized neuromuscular tissue located
within the right atrium
THE MUSCLES’ MAKEUP
 Fibers – muscle cells
 Fascia – fibrous membrane sheath that
encloses bundles of muscle fibers
 Sarcolemma – muscle fiber’s plasma
membrane
 Sarcoplasm – muscle’s cytoplasm
THE TIES THAT BIND US
 Tendons – bands of fibrous connective
tissue that attach muscles to the periosteum;
connect muscle to bone
 Ligaments – dense, strong, flexible bands of
fibrous connective tissue that bind bones to
other bones; connect the articular ends of
bones; provide stability and can either limit
or facilitate movement; deeper inside the
body, ligaments support organs (pelvic area);
connect bone to bone
PUTTING IT IN MOTION
 Prime movers – muscles that actively
produce a movement (bida)
 Antagonists – muscles that oppose the
prime movers and relax as the prime movers
contract (kontrabida)
 Synergists – contract along with the prime
movers and help execute the movement or
provide stability
 Origin – point where the muscle attaches to
the stationary bone
 Insertion – the point where it attaches to the
more movable bone insertion
COMMON COMPLAINTS
 Myopathy – refers to any disease of the
skeletal muscles
 Myalgia – muscle pain or tenderness
 Myoclonus – a spasm of a muscle
 Myotasis – a continual stretching of a
muscle, commonly referred to as a pulled
muscle
 Myotonia – chronic muscle contraction or
irritability
 Tenalgia – pain in the tendon
 Tetany – hyperexcitability of nerves and
muscles, which results from lessened
concentration of extracellular ionized calcium
 Tic – small muscle spasm
COMMON OBSERVATIONS
 Myelomalacia – muscle softening
 Myoatrophy – muscle wasting
 Myonecrosis – death of muscle fibers
 Myosclerosis – muscle hardening
 INTRO TO PT:
MUSCLE CONDITIONS
 Atrophy – wasting of muscle
 Contractures – the abnormal flexion and
fixation of joints
 Footdrop – inability to maintain foot in a
normal, flexed position (dragging of foot)
 Shin splint – strain of the long flexor muscle
of the toes that’s caused by strenuous
athletic activity
 Spastic paralysis – involuntary contraction
of a muscle with an associated loss of
function
 Sprain – complete or incomplete tear in the
supporting ligaments surrounding a joint
 Strain – an injury to a muscle or tendinous
attachment (tendon)
NERVOUS SYSTEM
CELLS OF THE NERVOUS SYSTEM
 Neurons – primary functional unit of the
nervous system; respond to stimuli and
transmit responses by means of
electromechanical messages
SHIPPING AND RECEIVEING
 Axons – conduct nerve impulses away from
the cell body
 Dendrites – conduct impulses toward the
cell body
 Myelin sheath – produced by Schwann cells;
made up of phagocytic cells; separated by
gaps (nodes of Ranvier)
BEING IMPULSIVE
 Neurotransmission – the purpose of a
neuron: to initiate, receive, and process
messages through electrochemical
conduction
NEURO-GLUE
 Neuroglia – supportive structures of the
nervous system; glial cells (Greek: glue)
FOUR TYPES OF NEUROGLIA
1. Astrocytes - exists throughout the nervous
system; supply nutrients to neurons to help
maintain their electrical potential; form part
of the blood-brain barrier
<3
Blood-brain barrier – separates CNS tissue from the
bloodstream and guards against invasion by disease
causing organisms and other harmful substances
1. Ependymal cells – line the ventricles (lines
structures); four small cavities in the brain,
also the choroid plexuses, vascular structures
that form a network in the pia matter of the
brain and project into the third, lateral, and
fourth ventricles; help produce cerebrospinal
fluid (CSF).
2. Microglia – phagocytic cells that ingest and
digest microorganisms and waste products
from injured neurons, giving them an
important role in host defense
3. Oligodendroglia – support and electrically
insulate CNS axons by forming protective
myelin sheaths
BRAIN
 Consists of the
 Cerebrum
 Cerebellum
 Brain stem
 Primitive structures that lie below the
cerebrum – diencephalon, limbic
system, and reticular activating system
CEREBRUM
 Has right and left hemispheres
 Corpus callosum – a mass nerve gibers;
bridges the hemispheres, allowing
communication between corresponding
centers in each
 Gyri – convolutions
 Sulcus – creases or fissures
 Gray matter – unmyelinated nerve fibers
 White matter – myelinated nerve fibers
(faster transmission of signals)
NAME THAT LOBE
 Frontal lobe – influences personality,
judgement, abstract reasoning, social
behavior, language expression, and
movement
 INTRO TO PT:
 Temporal lobe – controls hearing, language
comprehension, and storage and recall of
memories
 Parietal lobe – interprets and integrates
sensations, including pain, temperature, and
touch; also interprets size, shape, distance,
and texture; parietal lobe of the
nondominant hemisphere is especially
important for awareness of one’s body shape
 Occipital lobe – functions primarily to
interpret visual stimuli
CEREBELLUM
 Second largest brain region
 Lies posterior and inferior to the cerebrum
 Like the cerebrum, it has two hemispheres,
an outer cortex of gray matter and an inner
core of white matter.
 Functions to maintain muscle movement and
control balance
BRAINSTEM
 Lies immediately inferior to the cerebrum,
just anterior to the cerebellum
 Continuous with the cerebrum superiorly and
with the spinal cord inferiorly
 Composed of the midbrain, pons, and
medulla oblongata, the brain stem relays
messages between the parts of the nervous
system
 Has 3 main functions:
1. Produces the rigid autonomic behaviors
necessary for survival, such as increasing
heart rate and respiratory rate and
stimulating the adrenal medulla to produce
epinephrine
2. Provides pathways for nerve fibers between
higher and lower neural centers
3. Serves as the origin for 10 of the 12 pairs of
cranial nerves
MIDBRAIN
 Connects dorsally with the cerebellum and
extends from the pons to the hypothalamus
 Contains large voluntary motor nerve tracts
running between the brain and spinal cord
<3
PONS
 Connects the cerebellum with the cerebrum
and links the midbrain to the medulla
oblongata
 Houses two of the brain’s respiratory centers
that work with those in the medulla to
produce a normal breathing rhythm
 Also acts as a pathway between brain centers
and the spinal cord and serves as the exit
point for cranial nerves V, VI, and VII
MEDULLA OBLONGATA
 Most inferior portion of the brain stem
 A small, cone-shaped structure. It joins the
spinal cord at the level of the foramen
magnum, an opening in the occipital portion
of the skull
 Serves as an autonomic reflex center to
maintain homeostasis, regulating respiratory,
vasomotor, and cardiac functions
PRIMITIVE STRUCTURES
 Diencephalon – consists of the thalamus and
hypothalamus, which lie beneath the surface of the
cerebral hemispheres
 Thalamus – relays all sensory stimuli (except
olfactory) as they ascend to the cerebral
cortex; functions include primitive awareness
of pain, screening of incoming stimuli, and
focusing of attention
 Hypothalamus – controls or affects body
temperature, appetite, water balance,
pituitary secretions, emotions, and
autonomic functions (including sleep and
wake cycles)
 INTRO TO PT:
LIMBIC SYSTEM
 A primitive brain area deep within the
temporal lobe
 In addition to initiating basic drives such as
hunger, aggression, and emotional and
sexual arousal, the limbic system screens all
sensory messages travelling to the cerebral
cortex (I love u with all my limbic system)
SPINAL CORD
 Extends from the foramen magnum at the
base of the skull to the upper lumbar region
of the vertebral column
 The spinal nerves arise from the cord
 At the cord’s inferior end, nerve roots cluster
in the cauda equina
HORN OF SENSATION, HORN OF ACTIVITY
 within the spinal cord, the H-shaped mass of
gray matter is divided into horns, which consists
mainly of neuron cell bodies
 Cell bodies in the posterior horn primarily
relay sensations
 Those in the anterior horn play a part in
voluntary and involuntary (reflex) motor
activity
 white matter surrounding the outer part of these
horns consists of myelinated nerve fibers grouped
functionally in vertical columns, or tracts
Horns – gray matter
Tracts – White matter
<3
PATHWAYS IN THE BRAIN
 Nerve impulses to the brain follow sensory
pathways
 Nerve impulses from the brain – those that
control body function and movement-follow
motor pathways
SENSORY PATHWAYS
*(ASA afferent sensory ascending)
 Sensory impulses travel via the afferent (in
front), or ascending, neural pathways to the
brain’s sensory cortex in the parietal lobe,
where they’re interpreted
MOTOR PATHWAYS
 Motor impulses travel from the brain to the
muscles via efferent (from the back), or
descending pathways
 Originating in the motor cortex of the frontal
lobe, these impulses reach the lower motor
neurons of the peripheral nervous system via
upper motor neurons
 upper motor neurons originate in the brain
and form two major systems:
 Pyramidal system – also called the
corticospinal tract; is responsible for fine
motor movements (ex. Drawing) of skeletal
muscle; impulses in this system travel from
the motor cortex, through the internal
capsule, and to the medulla, where they
cross to the opposite side and continue
down the spinal cord
 Extrapyramidal system – extracorticospinal
tract; controls gross motor movements (ex.
Dancing); impulses originate in the premotor
area of the frontal lobe and travel to the
pons, where they cross to the opposite side;
then the impulses travel down the spinal
cord to the anterior horn, where they’re
relayed to the lower motor neurons. These
neurons, in turn, carry the impulses to the
muscles
 INTRO TO PT:
ITS ALL AUTOMATIC
 reflex responses occur automatically, without
any brain involvement, to protect the body (spinal
cord ra taman)
 Spinal nerves – which have both sensory
and motor portions, meditate deep and
superficial tendon reflexes
Deep tendon reflexes – involuntary contractions
of a muscle after brief stretching caused by
tendon percussion
Superficial reflexes – withdrawal reflexes elicited
by noxious or tactile stimulation of the skin,
cornea, or mucous membranes
PROTECTIVE STRUCTURE OF THE CNS
 Bones
 Meninges
 Several additional cushioning layers
 CSF (cerebrospinal fluid)
MENINGES
 Cover and protects the cerebral cortex and
spinal column
 Consists of 3 layers of connective tissue: the
dura matter, arachnoid membrane, and pia
mater
Dura mater – a fibrous membrane that lines the
skull and forms reflections, or folds, that
descend into the brain’s fissures and provide
stability
Arachnoid membrane – a fragile, fibrous layer of
moderate vascularity; lies between the dura
mater and pia mater
Pia mater – extremely thin; innermost layer; has
a rich blood supply; adheres to the brain’s
surface and extends into its fissures
CUSHIONING LAYERS
3 layers of space further cushion the brain and
spinal cord against injury
 Epidural space – (actually, a potential space)
lies over the dura mater
 Subdural space – situated between the dura
mater and arachnoid membrane; this closed
are-typically the side of hemorrhage after
head trauma-offers no escape route for
accumulated blood
<3
 Subarachnoid space – filled with CSF;
separates the arachnoid membrane and pia
mater
CEREBROSPINAL FLUID
 A colorless fluid that arises from blood
plasma and has a similar composition
 Cushions the brain and spinal cord, nourishes
cells, and transports metabolic waste
PERIPHERAL NERVOUS SYSTEM
 Consists of cranial nerves, spinal nervesm and
autonomic nervous system (ANS)
CRANIAL NERVES
 12 Pairs
 Transmit motor or sensory messages, or
both, primarily between the brain or brain
stem and the head and neck
 All cranial nerves, except the olfactory and
optic nerves, exit from the midbrain, pons, or
medulla oblongata of the brain stem
SPINAL NERVES
 31 pairs
 Named for the vertebra immediately below
each nerve’s exit point from the spinal cord
 Thus, they’re designated from top to bottom
as C1 (cervial spine) through S5 (sacral spine)
and the coccygeal nerve
 Each spinal nerve consists of afferent and
efferent neurons, which carry messages to
and from particular body regions called
dermatomes
AUTONOMIC NERVOUS SYSTEM
 Vast ANS innvervates all internal organs
 Sometimes known as visceral efferent nerves
 The nerves of the ANS carry messages to the
viscera from the brain stem and
neuroendocrine regulatory centers
 Has 2 major subdivisions
- Sympathetic (thoracolumbar) nervous system
- Parasympathetic (craniosacral) nervous system
 INTRO TO PT:
<3
COMMON PHYSICAL EXAMINATION TERMS
 Absence seizure – petit mal seizure, marked
by a sudden, momentary loss of
consciousness, typically accompanied by loss
of muscle control or spasms, and a vacant
facial expression; patient may experience
many seizures per day (kanang magtanga ka
ug déjà vu kay seizure na sya)
 Aphasia – loss or impairment of the ability to
communicate through speech, written
language, or signs. It typically results from
brain disease or trauma
 Aphonia – loss of ability to speak
 Apraxia – complete or partial inability to
perform purposeful movements in the
absence of sensory or motor impairment
 Ataxia – impairment of the ability to
coordinate voluntary muscle movement
 Ataxic speech – characterized by faulty
formation of sounds. It’s typically caused by
neuromuscular disease
 Athetosis – a condition characterized by
constant, slow, writhing, involuntary
movements of the extremities, especially the
hands
 Aura – word for the sensations that occur
before paroxysmal attack, such as seizure or
migraine headache
 Battle’s sign – discoloration of the skin
behind the ear following the fracture of a
bone in the lower skull
 Biot’s respiration – an abnormal,
unpredictable breathing pattern
characterized by irregular periods of apnea
alternating with periods of four or five
breaths of the same depth; indicated
meningitis, a lesion in the medulla, or
increased intracranial pressure
 Bradylalia – refers to abnormally slow
speech, caused by a brain lesion
 Brudzinski’s sign – flexion of the hips and
knees in response to passive flexion of the
neck; a positive Brudzinski’s sign signals
meningeal irritation
 Coma – a state of unconsciousness from
which the patient can’t be aroused
 Decerebrate posturing – associated with a
lesion of the upper brain stem or severe
bilateral lesions in the cerebrum; patient
typically lies with legs extended, head
retracted, arms adducted and extended,
wrists pronated, and the fingers, ankles, and
toes flexed
 Decorticate posturing – associated with a
lesion of the frontal lobes, cerebral
peduncles, or internal capsule; patient lies
with arms adducted and flexed, wrists and
fingers flexed on the chest, legs stiffly
extended and internally rotated, and feet
plantar flexed
 Delirium – an acute disorientation to time
and place; the patient may also experience
illusions and hallucinations
 Dementia – an organic mental syndrome
marked by general loss of intellectual
abilities, with chronic personality
disintegration, confusion, disorientation, and
stupor. It doesn’t include states of impaired
intellectual functioning resulting from
delirium or depression
 Dysphagia – difficulty swallowing
 Dysphasia – impairment of speech involving
failure to arrange words in the proper order,
usually resulting from injury to the speech
area in the cerebral cortex
 Dyspraxia – a partial loss of the ability to
perform coordinated movements, with no
associated defect in motor or sensory
functions
 Generalized tonic-clonic (grand mal)
seizure – an epileptic seizure that may be
preceded by an aura; this type of seizure is
characterized by loss of consciousness and
muscle spasms (tonic phase), followed by
convulsive movement of the limbs (clonic
phase)
 Headache – diffuse pain that occurs in
different portions of the head and is not
confined to any nerve distribution area
 Hemiparesis – refers to paralysis or muscular
weakness affecting only one side of the body
 Hemiplegia – paralysis of one side of the
body
 INTRO TO PT:
 Intracranial pressure (ICP) – the pressure
created by CSF in the subarachnoid space
between the skull and brain. ICP may
increase as a result of head trauma, brain
tumor, stroke, or infection in the brain
 Kernig’s sign – refers to resistance and
hamstring muscle pain that occur when an
examiner attempts to extend a patient’s knee
while the hip and knee are both flexed 90
degrees; this sign is usually present in a
patient with meningitis or subarachnoid
hemorrhage
 Neuralgia – severe pain in a nerve or nerves
THE CARDIOVASCULAR SYSTEM
THE HEART’S PROTECTORS
 Pericardium – thin sac that protects the
heart; has an inner, or visceral layer that
forms the epicardium and an outer, or
parietal layer
 Heart wall – composed of 3 layers
Epicardium – outer layer
Myocardium – heart muscle itself
Endocardium – innermost layer; lines the heart’s
chambers and covers its valves
THE FOUR CHAMBERS
 Atrium (plural: atria) – each of the two upper
chambers; are thin-walled chambers that
serve as reservoirs for blood; each atrium is
connected by its own valve to a chamber
below it
 Ventricles – 2 lower chambers; have thick
walls and are responsible for pumping blood
throughout the body
<3
BLOOD PATH
 Superior vena cava – carries blood from the
upper body to the right atrium
 Inferior vena cava – carries blood from the
lower body to the right atrium
THE HEART’S VALVES
 Two atrioventricular (AV) valves
 Tricuspid valve – separates the right atrium
from the right ventricle. It has 3 flaps or
cusps
 Mitral valve – separate the left atrium from
the left ventricle; has 2 flaps or cusps and is
also known as bicuspid valve
 Two semilunar valves
 Pulmonic valve – separates the right
ventricle from the pulmonary artery
 Aortic valve – valve between the heart and
the body
THE HEART’S RHYTHM
 Contractions of the heart occur in a rhythm -
the cardiac cycle – and are regulated by
impulses that normally begin at the
sinoatrial (SA) node, the heart’s pacemaker
-> the impulses are conducted from there
through the Atrioventricular (AV) node ->
down through the AV bundle, or the bundle
of His -> through the Purkinje fibers, where
the impulse stimulates ventricular
contraction
CARDIAC CYCLE
 Systole – the period when the ventricles
contract and send blood on an outward
journey to the aorta or the pulmonary artery
 Diastole – when the heart relaxes and fills
with blood; about twice as long as systole, to
allow for adequate filling of the ventricles;
during diastole, the mitral and tricuspid
valves are open, and the aortic and pulmonic
valves are closed
HEART SOUNDS
 Systole is the period of the ventricular
contraction. As pressure within the ventricles
rises, the mitral and tricuspid valves snap
 INTRO TO PT:
<3
closed. This closure leads to the first heart
sound, SI (the lub of lub-dub)
 At the end of the ventricular contraction,
pressure in the ventricles drops below the
pressure in the aorta and the pulmonary
artery. That pressure difference forces blood
to back up toward the ventricles and cause
aortic and pulmonary valves to snap shut,
which produces the second heart sound. S2
(the dub of lub-dub)
PUMPING IT OUT
 Cardiac output – refers to the amount of
blood pumped out by the heart in 1 minute
and is determined by the stroke volume
 Stroke volume – the amount of blood
ejected with each heartbeat multiplied by the
number of beats per min. In turn, depends
on 3 factors:
Contractility – refers to the ability of the
myocardium to contract normally
Preload – the stretching of muscle fibers in the
ventricles; this stretching results from the
volume of blood in the ventricles at the end of
diastole; the more muscles stretch, the more
forcefully they contract during systole (high
preload is good)
Afterload – refers to the pressure the ventricular
muscles must generate to overcome the higher
pressure in the aorta (high afterload is bad)
VASCULAR NETWORK
 Arteries – carry blood away from the heart,
nearly all arteries carry oxygen-rich blood
from the heart to the rest of the body; the
only exception is the pulmonary artery, which
carries oxygen-depleted blood to the lungs
 Capillaries – where the exchange of fluid,
nutrients, and metabolic wastes between
blood and cells occurs; are connected to
arteries and veins through intermediary
vessels called arterioles and venules
 Veins – carry blood toward the heart; nearly
all veins carry oxygen-depleted blood; the
sole exception to this is the pulmonary vein,
which carried oxygen-rich blood from the
lungs to the heart
PHYSICAL EXAMINATION TERMS
 Pulse – the expansion and contraction of an
artery in a regular, rhythmic pattern; this
happens when the left ventricle of the heart
ejects blood into the aorta as it contracts,
causing waves of pressure
 Blood pressure – maintained by complex
interaction of the homeostatic mechanisms
of the body and is influenced by the volume
of blood, the lumen of the arteries and
arterioles, and the force of the cardiac
contraction; when you take a blood pressure,
you’re measuring the pressure exerted by the
circulating volume of blood on the walls of
the arteries, the veins, and the chambers of
the heart
 Systolic blood pressure – blood pressure
caused by the contraction phase, or systole,
of the left ventricle of the heart; the top
number given in the blood pressure
measurement; for example, 120/80mmHg
 Diastolic blood pressure – pressure during
the heart’s relaxation phase, or diastole. It’s
the bottom number given in blood pressure
measurement; for example, 120/80 mmHg
 Pulse pressure – the numerical difference
between the systolic and diastolic bp; for
 INTRO TO PT:
<3
example, if the patient’s bp reading is 120/80
mmHg, the pulse pressure is 40. (if dako ang
difference its vbad)
ABNORMALITIES IN THE PHYSICAL
EXAMINATION
 Bruit – a murmur, soft blowing, or fluttering
sound of cardiac or vascular origin heard
during auscultation; an abnormal sound
heard over arteries that indicated turbulent
blood flow
 Cyanosis – bluish discoloration of the skin
and mucous membranes that results from an
excessive amount of deoxygenated
hemoglobin in the blood or a structural
defect in the hemoglobin molecule
 Pallor – term for paleness or a decrease or
absence of color in the skin; assessing the
patient’s conjunctiva may also be helpful in
patients with cyanosis or pallor; a normal
conjunctiva should be pink, a pale color
could indicate lack of oxygenated blood flow
 Edema – accumulation of abnormal amounts
of fluid in the intercellular tissues, pericardial
sac, pleural cavity, peritoneal cavity, or joint
capsules
 Diaphoresis – profuse perspiration
associated with an elevated body
temperature, physical exertion, heat
exposure, and mental or emotional stress
 Angina – angina pectoris; chest pain that
lasts several minutes and results from an
inadequate supply of oxygen and blood flow
to the heart muscle