PERCEPTION &

COORDINATION

Overview of
Anatomy & Physiology

Perception & Coordination

 NEUROSENSORY
SYSTEM
NERVOUS SYSTEM
1. CENTRAL NERVOUS SYSTEM
a. Brain
b. Spinal cord

2. PERIPHERAL NERVOUS SYSTEM

a. Cranial Nerves
b. Spinal Nerves
c. Autonomic Nervous System

SENSORY ORGANS
Perception & Coordination
 The Brain
 Cerebrum
2 hemispheres/ 4 lobes
 Corpus callosum
 Basal ganglia
 Diencephalon
 Thalamus
Corpus callosum
 Hypothalamus
 Brain stem
 Midbrain, pons, medulla
 Cerebellum
thalamus
hypothalamus

Perception & Coordination

 Frontal lobe


Personality, behavior
Higher intellect Cerebrum
 Precentral gyrus: motor fxn
 Broca’s area: specialized
motor speech area
 Parietal lobe
 Postcentral gyrus: general
sensation
 Integrates sensory info
 Temporal lobe
 Hearing, smell, taste
 Wenicke’s area: sensory
speech area
 Occipital lobe
 Vision

Perception & Coordination

The Spinal Cord
 Gray matter
 Anterior horns
 Posterior horns
 Lateral horns

 White matter
 Ascendingtracts
 Descending tracts

Perception & Coordination

 Axon

The Neuron
 Transmit impulses away from
cell body

 Dendrites
 Receive impulses

 Synapse
 Junction bet. neurons where
impulse is transmitted

 Myelin sheath
 Protect & insulate; enhance
impulse conduction

 Neurotransmitters
 Chemical agents involved in
transmission of impulse Terminal branches
across synapse Nucleus of of axon
Schwann cells
Perception & Coordination
The Reflex Arch

Perception & Coordination

 Neurotransmitters
EXCITATORY
Acetylcholine –triggers muscle contraction
stimulates hormone excretion
(Lack : Alzheimer’s dse)
Epinephrine –initiates fight or flight responses
Norepinephrine –affects mood & overall activity
for attentiveness & learning
(lack: Mood d/o – depression)
Glutamic Acid –for learning & memory
(assoc: Alzheimer’s dse)
Enkephalin– pleasurable sensations,
Endorphin inhibits pain transmission
INHIBITORY
GABA ( Gama Amino Butyric Acid )
– for motor control and vision
Serotonin – inhibits pain pathways
regulates temp, appetite,
mood
(imbalance: suicide
aggressiveness)
Dopamine –affects behavior
(attention, emotions)
controls fine movement
(Loss: Parkinson’s disease)
Acetylcholinesterase
– inhibits acetylcholine
Perception & Coordination
 Supporting Structures
 Skull
 Spinal/ vertebral column
 Meninges
 Ventricles
 Cerebrospinal fluid (CSF)
 Blood-brain barrier (BBB)
 Vascular supply

Perception & Coordination

 Skull Sagittal suture
Coronal suture

Lambdoidal suture

Squamosal suture

Perception & Coordination

Vertebral Column
7 cervical
12 thoracic
5 lumbar
Sacrum
Coccyx

Perception & Coordination

 Meninges
EPIDURAL SPACE

SUBARACHNOID SPACE

Perception & Coordination

Ventricles

Perception & Coordination

 CSF
 Clear, colorless fluid
 Specific gravity = 1.007
 Total production = 400-
500 ml/day
HYDROCEPHALUS
 Normal resting pressure
= 150-180 mm H2O. Taken: August 11, 2004
DMC Pedia Ward
 Contents = albumin,
Glucose, chloride, lactic
acid, Glutamine, IgG,
protein, WBC trace VP – SHUNT
(VENTRICULO-
PERITONEAL)

Perception & Coordination

BBB

Perception & Coordination

FUNCTIONS OF THE BBB
 Protects the brain from "foreign
substances" in the blood that
may injure the brain.

 Protects the brain from hormones

and neurotransmitters.

 Maintains a constant
environment for the brain.

Perception & Coordination

 Cerebral Circulation
Cerebral Circulation = 15% of Cardiac Output
750 ml of blood passes through the brain each minute

Collateral Circulation – provides blood to brain tissue

Circle of Willis – ring of arteries formed at base of brain

Occlusion of blood flow = irreversible tissue damage

Perception & Coordination

 Peripheral Nervous System

• CRANIAL NERVES

• SPINAL NERVES

• AUTONOMIC NERVOUS SYSTEM

Perception & Coordination

I OLFACTORY S Sense of smell

II OPTIC S Central & Peripheral vision

III OCULOMOTOR M Eye mvmt, elevation of eyelid

IV TROCHLEAR M Downward & inward eye mvmt

V TRIGEMINAL B-S Touch,pain, temp, jaw & eye mus

-M Mastication

VI ABDUCENS M Abduction of eye

VII FACIAL B-M closed eyelid, mus of facial exp

-S taste ( ant 2/3 of tongue )

VIII ACOUSTIC S Equilibrium (Vestib), Hearing (Coch)

IX GLOSSOPHARYNGEAL B-M Movemt of pharyngeal muscles

-S Pharyngeal & post tongue sensatn

X VAGUS B-M Pharyngeal & laryngeal mvmt

-S P & L sensation, taste

XI SPINAL ACCESSORY M sternocleidomastoid, trapezius mvt

XII HYPOGLOSSAL M Tongue Movement

Perception & Coordination

Spinal Nerves

Perception & Coordination

 31 segments:
8 cervical,
12 thoracic,
5 lumbar,
5 sacral and
1 coccygeal.

A pair of spinal nerves exits from

each segment of the spinal cord.

Perception & Coordination

Autonomic Nervous System

Perception & Coordination

 Structure Sympathetic Stimulation Parasympathetic Stimulation

Pupil Dilation Pupil Constriction

Iris (eye muscle)
Near vision accommodated Far vision accommodated

Salivary Glands Saliva production reduced Saliva production increased

Oral/Nasal Mucosa Mucus production reduced Mucus production increased

Heart rate and force decreased

Heart Heart rate and force increased; coronary vessels dilate
Coronary vessels constrict

Bronchial muscle relaxed Bronchial muscle contracted

Lung
(bronchodilation) (bronchoconstriction)

Stomach Peristalsis reduced Gastric juice secreted; motility increased

Small Intestine Peristalsis reduced; inhibited secretion Digestion increased, stimulated peristalsis

Large Intestine Peristalsis reduced; inhibited secretion Secretions and motility increased

Increased conversion of
Liver Hepatic glycogenesis
glycogen to glucose ( glycogenolysis & lipolysis )

Kidney Decreased urine secretion Increased urine secretion

Norepinephrine and
Adrenal medulla
epinephrine secreted

Wall relaxed Wall contracted

Bladder
Sphincter closed Sphincter relaxed / open

Penis Ejaculation Erection

Perception & Coordination

 SENSORY ORGANS – VISION
THE EYE

Accommodation – process by which

the eye adjusts viewing distances
of an object by changing the curvature
of its lens to focus a clear image on
the retina.
Photoreceptors: Rods & Cones
Rods – night vision / low light
Cones – bright light/ color visionPerception & Coordination
/ fine detail
SENSORY ORGANS – AUDITION
THE EAR

Sound waves Tympanic = Vibration of ossicles

Membrane
Pass vibz to the cochlea – organ of Corti

Then hair cells in the cochlea contact the

Tectorial membrane to generate impulses to
Auditory nerve to the brain
= hearing is perceived
Perception & Coordination
SENSORY ORGANS – OLFACTION

The Olfactory System

Hair cells are the receptors in the olfactory epithelium
that respond to particular chemicals. These cells have
small hairs called cilia on one side and an axon on the
other side. In humans, there are about 40 million
olfactory receptors; in the German Shepherd dog, there
are about 2 billion olfactory receptors.

Perception & Coordination

SENSORY ORGANS – GUSTATION
Soft
VII Facial Palate
Greater Superficial Petrosal Epiglottis
X Vagal Nerve
Superior Larygeal
IX Glossopharygeal
Lingual Tonsilar Anterior
third
VII Facial
Chorda Tympani
 Palatability is biologically important in determining appropriate food
selection. (most poisons are bitter)
For food to have a taste, it must be dissolved in water. There are four basic tastes:
sweet, salty, sour and bitter:
SWEET SOUR SALTY BITTER
 SENSORY ORGANS – TACTILE
Receptors Nerve Fiber Function / Location

A-beta Responds to hair displacement.

Wraps around hair follicle in, of
course, hairy skin.

Hair Follicle Ending

A-beta Responds to pressure on skin.
Dermis of both hairy and glabrous
skin.

Ruffini Endings
A-beta Responds to pressure
Lips, tongue, and genitals.

Krause corpuscle
SENSORY ORGANS – TACTILE
Receptors Nerve Fiber Function / Location

A-beta Responds to vibration. Most sensitive

Deep layers of dermis in both hairy

and glabrous skin.
Pacinian corpuscle
Responds to vibration.
A-beta Dermis of
glabrous skin.

Meissner corpuscle
Different types of free nerve endings
A-delta and C that respond to mechanical, thermal
or noxious stimulation.

Responds to pressure of the skin.

Merkel Cells
Free nerve endings Epidermis of glabrous skin.
 ASSESMENT
Health History
1. Family history–epilepsy ,glaucoma/cataracts
2. History of problem
3. Headaches, Seizures
4. Medications
5. Recent change in behavior or
personality
6. Interview of sensory perceptions, deficits
and other problems
a. Visual – difficulty seeing near or far
objects, wearing of eye glasses or contact
lenses, visual disturbances
b. Auditory – difficulty hearing or changes in
hearing, wearing of hearing aids, can
determine location of sounds, distinguish
various voices, experience humming,
ringing, buzzing, crackling noises in ears
c. Gustatory – changes in ability to taste
d. Olfactory – changes in ability to smell
Perception & Coordination
 ASSESMENT
Neurological exam
1. Cognitive function / Mental status
a. Intellectual function
b. Thought content
c. Emotions / Affect
d. Perception
e. Language ability
f. Body language / Posture
g. Orientation
h. Level of Consciousness
i. Attention Span
2. Cerebral function
a. Balance and coordination
3. Motor Function
a. Tone / size
b. Strength
c. Coordination
d. Posturing
4. Sensory function Perception & Coordination
 NEUROLOGIC EXAM
1. Cognitive function / Mental status
a. Intellectual function
- Knowledge of current events
- Memory
- Calculation
- Use of judgment
- Attention span
b. Thought content
- spontaneous, natural, clear, relevant
coherent
- no fixed ideas, illusions, preoccupations
( ex. With death, morbid events,
hallucinations, paranoid ideations )
c. Emotions / Affect
- external manifestation of mood: angry
irritable, anxious, apathetic, euphoric
- normal mood fluctuation, unpredictable
mood swings from sadness to joy
- consistency in verbal & nonverbal cues
Perception & Coordination
 NEUROLOGIC EXAM
1. Cognitive function / Mental status
e. Language ability
- can understand and communicate spoken &
written language
- answer questions appropriately
- can read a sentence and explain meaning
- Aphasia - deficiency in language function
Broca’s aphasia / non fluent aphasia
: choppy, broken words, short meaningful
phrases produced with great effort
: ex – Walk dog.
Wernicke’s aphasia / fluent aphasia
: speak fluently but with no meaning
: add unnecessary words; create new words
: ex – you know that smoodle pinkered & that I
want to get him round & take care of him like
you want before. = The dog needs to go
outside so I will take him for a walk
Global aphasia : with severe communication
difficulties and may be extremely limited in their
ability to speak or comprehend language
Anomia – problem with word finding. They know what
Perception & Coordination
 NEUROLOGIC EXAM
1. Cognitive function / Mental status
f. Body language
- Posture, gestures, movements
- Facial expression
g. Orientation
- To time, place and person
h. Level of Consciousness
1 conscious / alert
2 lethargic / somnolent / drowsy
3 obtunded
4 stuporous / light coma / semicoma
5 deep coma stimuli
- Glasgow coma scale
i. Attention Span
2. Cerebral function
a. Balance and coordination
- point to point testing
- assess speed, symmetry & degree of diff
- Romberg test Perception & Coordination
 GLASGOW COMA SCALE
 Eye opening
Spontaneous 4
To voice 3
To pain 2
None 1
 Verbal responsiveness
Oriented 5
Confused conversation 4
Inappropriate words 3
Incomprehensible
sounds 2
None 1
 Motor responsiveness
Obeys commands 6
**TRAUMA SCORE** Localizes to pain 5
Flexor withdrawal
A score of 15 indicates
4
client is awake and oriented; the
lowest score,flexion
Abnormal 3, is deep coma; a score 3 of 7 or below is
considered coma Extension 2
Perception &Flaccid
Coordination
 NEUROLOGIC EXAM
3. Motor Function
a. Tone / size
- note atrophy, rigidity, spasticity
b. Strength
- flex or extend extremities against
resistance
c. Coordination
- tested by having patient to run
the heel down the anterior surface
of the tibia of the other leg
- Ataxia : incoodination of voluntary
muscle action
d. Posturing
Decorticate posture – corticospinal tract:
rigid flexion of arms, wrists and fingers
with adduction of upper extremities, &
extension with internal rotation of legs,
Decerebrate posture – midbrain & pons:
rigid extension of neck, back, arms &
Perception & Coordination
 2 4 5 – full range of motion against gravity &
1 5 resistance
4 – full range of motion against gravity &
moderate amount of resistance
3 – full range of motion against gravity
1 5 only
2 – full range of motion when gravity is
eliminated
1 – a weak muscle contraction when
2 5 muscle is palpated
0 – complete paralysis

Perception & Coordination

4. sensory function
- superficial sensation
- superficial pain
- sensation to temperature & vibration
- vision: pupils, glasses, contact lenses
distortions:
halos around lights
difficulty in adjusting to dark room
diplopia
floaters
ptosis
anisocoria
nystagmus doll’s eye
- hearing: amount of hearing – aids, tinnitus
hearing loss
1. conductive hearing loss
( outer / middle ear ) 2.
sensory hearing loss / perceptive
loss ( inner ear )
5. reflexes
superficial
abdominal reflex
babinski (plantar) reflex
Perception
corneal (blinking) & Coordination
reflex
 
EYE
Pupils size and symmetry
EXAM
 Spontaneous eye movements
 Pupillary reactions (direct & consensual)
 Corneal reflex
 Occulocephalic reflex
 External eye and orbital exam

GRADING OF REFLEXES
Funduscopic exam

++ ++ 0 – No response
++ ++ ++ ++ 1 – Diminished (Hypoactive)
2 – Normal
++ ++ 3 – Increased
4 – Hyperactive ( hyperreflexia )

++ ++

+ +
 DIAGNOSTIC EXAMS
1. X-rays of skull and spine- Used to detect atrophy, erosion or fractures
of bones; calcifications

2. Computerized Tomography Scan

- info obtained to construct a picture of the internal
structure of the brain; contrast medium may or
may not be used.
- obtain consent, check allergies, if with dye NPO 4
hours prior, assess for claustrophobia, explain

3. MRI-Magnetic Resonance Imaging

- 3D images, obtain consent & remove all metal
objects

4. Brain Scan
- Method: IV radioisotope to detect neoplasms,
brain abcess, subdural hemorrhage
- Obtain consent, explain procedure

5. MYELOGRAPHY
Perception & Coordination
 DIAGNOSTIC EXAMS
6. Cerebral Angiography
- Dye is injected to artery and vascular system
- Obtain consent, clear liquids before procedure
May have sedative, void before procedure, mark
distal pulses, warn client on feeling of warmth in
face during procedure
- Post: Monitor for LOC, hematoma, put ice cap to
site, extension of involved extremity, maintain
bed rest overnight, check peripheral pulses, color,
and temperature of extremeties

7. Encephalography-use of ultrasound to detect midline shift of

intracranial contents due to brain tumors, hematomas

8. Lumbar Puncture (LP)

- needle inserted between L4 – L5 to w/draw CSF
- obtain consent, empty bladder, in fetal position
- post: flat on bed, encourage OFI, check site for
bleeding, redness, swelling, clear drainage,
assess movement of extremeties
Perception & Coordination
 DIAGNOSTIC EXAMS
10. Electroencephalography
- graphic recording of electrical activity of the brain - Used to detect
focus of seizure activity and to
quantitatively evaluate level of brain function
- Obtain consent, verify meds to be administered,
withhold caffeine or sedatives before EEG, no
styling gels or sprays on hair before EEG
- assist client in cleansing hair

11. Eye Exams

a. snellens test (eye chart)
Farsighted – Hyperopia
Nearsighted – Myopia
b. Ophtalmoscopic exam
c. Ocular tension test

12. Ear tests

a. otoscopic exam
b. whisper test
c. Weber test( bone conduction )
Perception & Coordination
 DIAGNOSTIC EXAMS
The figures below show the human brain in the three
planes of section on "synthetic MR" images produced

Coronal Section Horizontal Section

Sagittal Section

Perception & Coordination

 Eye Safety
 Your eyes are the windows to your
brain - Protect Them!
Here are some safety tips for caring for your eyes.

Walk, don't run, with sharp objects such as scissors, pens,

pencils and rulers

Avoid guns, bow-and-arrows, sling shots and firecrackers

Use good lighting to avoid tiring your eyes when reading, writing
or cruising the Internet
Learn basic first aid for your eyes in case an injury does
occur.

Tell your parents, school nurse or teachers if your eyes are

bothering you.

Perception & Coordination

 Eye Safety
Wear proper eye protection when you are doing hazardous
hobbies, chores or mixing chemicals

Wear sunglasses that block both ultraviolet-A and ultraviolet-

B radiation from the sun

Never look directly at the sun

Point chemical sprays away from your face BEFORE

spraying

Wear a helmet when biking, skateboarding or rollerskating

and wear your seatbelt in the car.

Perception & Coordination

Perception & Coordination