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Atienza, Batacan, Casas, Chu, Revilleza VPHY 141 Group 1-5L Experiment 7 Neurologic Examination in Dogs: Evaluation of spinal

nerves and pain assessment

I.

Introduction The nervous system is composed of the brain and the spinal cord and sensory

and motor neurons which control almost all of the activities of the animals body. Any deviation from the normal function may change the response of the animal to different stimuli. An abnormality or defect can be related to the damage of a part of the nervous system. An examination called neurological examination can be performed in order to assess the condition of an animal whether it responds normally or not. It is also necessary to perform this examination in order to come up with an immediate diagnosis to lessen the damage. evaluation and pain assessment. The spinal nerves are group of nerve roots which arise from the Peripheral Nervous System (PNS) consisting of the sensory or afferent and motor or efferent neurons. The motor or efferent neuron transmits signals from the brain to the spinal cord then to the muscles and it is divided to Upper Motor Neuron and Lower Motor Neuron. The Upper Motor Neuron (UMN) located in the cerebrum and brain stem, initiates reaction to sensory inputs and descends to the spinal cord segments. Lower Motor Neuron (LMN) cell bodies are in the spinal cords grey matter and its axons are located in the spinal nerves. UMN influences the activity of LMN causing voluntary muscle activity. The evaluation of spinal nerves is divided into evaluation of muscle tone, the evaluation of spinal reflexes and evaluation of pain through flexor reflex. These examinations test the integrity of sensory (afferent) and motor (efferent) components of the reflex arc and the influence of descending motor pathways on the reflex. According to Lorenz and Kornegay (2004) these spinal nerves One of the most important neurologic examinations that can be performed in the animal is the spinal nerve

examinations can elicit three kinds of responses; the absence or depression of a reflex specifies complete or partial loss of their sensory or motor (LMN) components of the reflex; a normal response specifies that both sensory and motor components are intact; and an exaggerated response specifies an abnormality in the motor pathways (UMN) that generally inhibits reflex responses or a discrepancy in opposing muscles which can be an indication of paresis. Reflexes or a Reflex action pertains to an involuntary response due to excitation of muscles from a stimulus without a necessary intervention of a conscious nervous activity. Eliciting this reflex assessment will help detect if there are lesions in the spinal cord in an animal. The Reflex arc is the neural path of a reflex as seen on Fig. 7.1 which is basically composed of five parts; 1 receptor organ, 2 sensory or afferent neuron, 3 one or more synapse(interneuron) , 4 motor or efferent neuron, and 5 target or effector organ as the stimulus is perceived by the receptors .

3 2 1
4

Fig. 7.1 Reflex Arc

When a noxious stimulus is elicited on a receptor organ, the afferent neuron enters the dorsal root to synapse on interneurons then the motor neurons are activated causing a reflex reaction or a jerk from the effector organ. II. Objectives The experiment aims to perform a neurological exam for dogs using the clinical assessment of the spinal nerves and pain evaluation through the examination of the animals reflex action. The main objective is to be familiar with the effects of spinal

nerve discrepancies that may determine the problem which can be caused by a lesion on the nervous system.

III.

Material and Methods The animal used for the experiment is a dog along with other materials needed

for the spinal reflex evaluation are the hemostat forceps for pain evaluation; the neurologic hammer for knee jerk reflex evaluation; a cotton and alcohol. The procedure of the experiment is seen on the Diagram 7.1 where the dog is placed in lateral recumbency and the three spinal reflex evaluations; evaluation of muscle tone, spinal reflexes and pain are performed by the group.

Diagram 7.1 Procedures of Spinal Reflex Evaluation. IV. Results and Discussion

Table 7.1 Observation of muscle tone of the dog. Muscle Tone Extension of elbow joint Flexion of elbow joint Extension of carpal joint Flexion of carpal joint Extension of knee joint Flexion of knee joint Extension of tarsal joint Flexion of tarsal joint Degree of Resistance Normal Normal Normal Normal

Table 7.1 shows normal muscle tone of the animal when the elbow, carpal, knee, and tarsal joints were extended and flexed. The positive result of the experiment should show is that there is a resistance of the thoracic and pelvic limb but it should be of normal degree. A normal response was observed during evaluation. The normal reaction is considered by a mild muscle contraction or resistance when the joints of the thoracic and pelvic limbs are passively manipulated. If the animals had a hypotonic reaction there is a decrease in muscle tone or flaccidity where the lesion can be found on LMN and if it had a hypertonic reaction thus theres a reaction of rigidity in extending the limb and a difficulty in passive manipulation where the lesion can be found on the UMN. Table 7. 2. Patellar reflex of the dog. Assessment(0 to 4+) +2

Patellar Reflex

Table 7.2 showed a normal or +2 patellar reflex of the dog examined. Hitting the patellar ligament extends the quadriceps muscle. This is because the impulse is transmitted by the dorsal root of the spinal nerve to the motor neuron causing the muscle to suddenly contract or stretch and causing a reflex muscle action which is normally seen on the knee jerk reflex (as seen on Fig. 7.1). Absence (0) of knee jerk reflex would indicate a lesion on sensory or motor component of the reflex arc; Depression (+1) of the reflex has the same significance as absence of the reflex except that the lesion is incomplete. Exaggerated reflexes (+3, 4+) can also cause increased extensor tone due to the loss of inhibitor pathways, the voluntary motor pathways facilitate the flexor muscles and inhibits extensor muscles . Clonus (+4) is a repetitive contraction and relaxation of the muscle from a single stimulus and is generally observed in chronic loss of descending inhibitory pathways.

Table 7. 3.Pelvic reflex of the pelvic limb of the dog. Assessment (+ or -) +

Pelvic limb flexor reflex

When the base of the toenail of the dog was pinched (stimuli), the animals normal response is by flexing its limb including the hip, stifle and hock. The response involves all of the flexor muscles of the limb thus requires activation of motor neurons in several of the spinal cord segments (see Fig. 7.2). A stimulus that produces a sensory discharge in these nerves ascends to the spinal cord through the dorsal root. The sensory nerves from the digits of the pelvic limbs are primarily branches of the sciatic nerve (originates from L6-S1), superficial peroneal nerve and tibial nerve on the dorsal and plantar surface. The interneuron activates the sciatic motor neurons which stimulate flexor muscle contraction thus the animal withdraws its limb from the applied noxius stimulus.

Fig. 7.2 Flexor and crossed extensor reflex

Absence or depression (-) of the animals reflex can indicate a lesion of L6-S1 segments origin branches of the sciatic nerve. Unilateral absence of the reflex is more likely the result of a peripheral nerve lesion whereas bilateral absence or depression is more likely the result of a spinal cord lesion. The normal (+) reflex suggests that the specified segments are functioning normally.

Table 7.4 Specific observable sensory, motor, and autonomic deficits when there is spinal cord defect

Spinal Cord Segments

Motor Signs

Autonomic

Sensory Signs

Cervical 1-4

Tetraplegia w/ hyperreflexia Apnea, no micturition

Anesthesia

Cervical 5-6

Tetraplegia w/ hyperreflexia Apnea, phrenic n. LMN suprascapular n. LMN, no micturition

Hypalgesia, hyperesthesia, midcervical

Cervical 7-Thoracic 1

Tetraplegia/Paraplegia w/ hyperreflexia, LMN brachial plexus

Diaphragmatic breathing only, no micturition

Anesthesia, hyperesthesia, brachial plexus

Thoracic 2-Lumbar 3

Paraplegia w/ hyperreflexia, Schiffo Sherrington syndrome

Anesthesia, hyperesthesia, segmental

Diaphragmatic, some intercostals and abdominal respiration depending on level, no micturition

Lumbar 4-Sacral 1

Paraplegia w/ LMN lumbossacral plexus

Anesthesia, hyperesthesia, segmental

No micturition, SI anal sphincter may be atonic

Sacral 1-3

Knuckling hind foot and paralysis of tail

Anesthesia, hyperesthesia, segmental

No micturition, sphincters atonic

Coccygeal 1-

Paralysis of tail

Anesthesia, hyperesthesia, segmental

none

Presented on Table 7.4 the spinal cord defects observed are motor, sensory and autonomic deficits. Under motor deficits are Hyperreflexia excessive reflex actions/response; Hyporeflexia deficient or slow reflex response; Paraplegia paralysis, motor and sensory loss of the hind limbs and Tetraplegia complete or partial paralysis of all four limbs. The observed sensory deficits are Anesthesia loss of sensation especially to pain; Hypalgesia decreased pain sense and Hyperesthesia abnormal extreme sensitivity. And the autonomic deficits discerned are Apnea absence of spontaneous respiration; no movement of respiratory

muscles, lung volume is unchanged; Atonic lack of response to stimuli and Micturition urination. Pain is an animals reaction to a noxious stimulus which can be initiated by the excitement of pain receptors which are free nerve endings that are widespread in the superficial layers of the skin and some internal tissues. The evident behavioral expressions of pain are growling, hissing and biting and retraction of the disturbed part. There are also less obvious signs which include increase in respiration, blood pressure and heart rate, dilation of the pupils and behavioral depression. Pain can be classified according to duration or location. Duration can be either Acute or Chronic. Acute pain could be sudden, lasts for hours or days while chronic pain can exist for months or years. Location can be Somatic, Visceral or Neuropathic. Somatic can occur in cutaneous or musculo-cutaneous tissues; visceral in the thoracic, abdominal or pelvic viscera and lastly neuropathic in the nervous system due to trauma or chemical injury.

V. Conclusion The evaluation of spinal nerve and pain assessment are integral part of the neurological examination. Any deficits or abnormal respond of the animal will signifies damage in the spinal nerves or spinal cord deficit (motor, sensory, or autonomic). As future veterinarians having knowledge on neurological examination especially on Spinal Nerve Reflex Evaluation is important in examining the neurological stability of the animal.

VI. References

Cunnigham J. G. & Klein B. G. (2007). Textbook of Veterinary Phyiology. 4th ed. Elsevier Saunders.

Guyton, A. (2006). Textbook of Medical Physiology. Pensylvania: Elsevier Saunders.

Lorenz, Michael and Kornegay, Joe. (2004). Handbook of Veterinary Neurology. 4th ed. Elsevier Saunders. (pp. 14, 19-21, 23-25) Merriam-Webster Incorporated. (2012). Merriam-Webster's Dictionary. Springfield, Massachusetts:Merriam-Webster Incorporated. McDonough, J. T. (1994). Stedman's Medical Dictionary. Baltimore: William & Wilkins.