Heritage High School

Anatomy and Physiology Honors

Mr. Beauman
Case Study: Wearing on Her Nerves
Ciana Cummings, Hannah Johnson, Ashley Levins, Maggie Loutzenheiser, Autumn McCool
2 May 2018
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1. Do What components of the nervous system are involved in physical sensation? How
does sensory impulse move throughout the body? (Autumn)

The nervous system is a system within the body in which all of the muscles, voluntary
and involuntary, are controlled. It consists all of the nerve cells in the body, called neurons.
Neurons are cells that act as a messenger throughout the body. These cells receive and send
messages from the brain in order to carry out an action, or a reaction. This is all possible due to
its structure. Neurons are formed with two seperate ends that connect with other neurons. On one
end there are the dendrites, which are the annexes of the neuron responsible for moving electrical
signals from the synapse to the body of the cell, and the other is the axon terminal, or the end of
an axon, with the axon in
the middle. The axon is the
body of the neuron, which
receives an electrical signal
down its length. When this
signal reaches the end of the
axon, it is converted into a
chemical signal in order to
be passed on as chemical
messengers known as
neurotransmitters. These
chemical messengers move
down to a space between
the end of the axon and the
beginning of a dendrite of
another neuron. This microscopic space is called a synapse. The neurotransmitters cross through
this synapse and onto the dendrite of the neighboring cell to be converted back into an electric
signal, continuing the cycle as it spreads through the body (PubMed Health, 2016).
The process of movement of these electrical and chemical impulses are what makes humans have
the capability to trigger reactions, such as the movement of muscles, or the ability to feel
pressure or pain. If an individual were to touch their hand on a hot stove, the nervous system
would immediately begin the process of transmitting these signals of pain to the brain and back
to the body in order to create the reaction of moving their hand away from the pain. This process
is very efficient and quick, only taking a couple of milliseconds to complete (PubMed Health
ND).
The nervous system is divided into two types: The Central Nervous System (CNS) and
the Peripheral Nervous System (PNS). The CNS is the part of the nervous system that contains
the brain and spinal cord. It is the control system, combining information gathered from the body
in order to systematize movement and controls. The CNS manages emotions, thoughts,
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breathing, involuntary and voluntary movement, the maintaining of homeostasis, and many other
actions and reactions of the body. The PNS connects the CNS to the rest of the body, sensory
organs, muscles, organs, blood vessels, and glands. The PNS contains sensory neurons and
motor neurons. Sensory neurons are nerves that are responsible for inform the CNS of the
external stimuli in order to convert it into internal electrical impulses. For example, if you grab a
handful of ice, the information goes from your hand to your CNS via the sensory neurons, which
tells you that the ice is cold. Motor neurons are nerves that form a pathway in which impulses
move along from parts of the CNS to the muscle or gland. These two neurons work together on a
daily basis. For example, sensory neurons can respond to a sense of touch and can activate motor
neurons in order to create a contraction in the muscles (Kimball, 2016).
The Peripheral Nervous System consists of two subdivisions. These are the
Sensory-Somatic Nervous system and the Autonomic Nervous system. The Sensory-Somatic
Nervous System contains two different types of nerves, cranial and spinal. Cranial nerves are
nerves that stem straight from the brain. These nerves manage many different features of the
body such as the sense of smell, motor function, and the movement of the muscles. There are 12
types of cranial nerves within the body. The cranial nerves have the functions of controlling all
of the senses and movements in the face and other parts of the body including movement of the
eye and the ability to see, smell, hear,
produce saliva, balance, etc (Nelson 2018).
This is all possible due to the sensory and
motor nerves within the Sensory-Somatic
Nervous System which allow an individual
to process the information and the stimuli
present in its environment. Spinal nerves
carry motor and sensory signals between the
spinal cord and the body. Humans have 31
spinal nerves that contain sensory and
motor axons. Within the spinal nerves, the
sensory nerves are grouped together in
structures called Dorsal Root Ganglia
shown in the picture to the left. The motor
neurons are are located in the grey matter of the spinal cord that extend towards the muscle by
means of the ventral root. Thes motor neurons are regularly stimulated by the sensory neurons or
by or interneurons in the spinal cord (Lumen Learning ND).
The Autonomic Nervous system is the part of the PNS thats main function is to cater to
the internal organs in the form of maintaining homeostasis. This means that the system
involuntarily regulates body processes such as temperature and blood pressure. Some organs that
rely on the Autonomic system are the liver, stomach, lungs, heart, and sweat glands. There are
two subdivisions: The Sympathetic and Parasympathetic nervous systems. The body uses either
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one of these divisions of the Autonomic system after it receives external information coming to
the body. Depending on the stimulant, the body can trigger body processes using the sympathetic
division, or it can slow down certain body processes using the parasympathetic division. The
function of the Sympathetic NS is to respond to a possible threat. This reaction usually comes in
the form of a ‘fight or flight’ response. This includes the dilation of airways, release of stored
energy, vasoconstriction, or the constriction of blood vessels in order to reduce the flow of blood
and retain body heat, the acceleration of the heart, the stimulation of sweat glands, the secretion
of norepinephrine and epinephrine in order
to aid in attentiveness and heart rate
increase, and the inhibiting of digestion in
order to save energy in the body (Low
ND)
The Parasympathetic Nervous
System has the opposite function. It’s
function is to control homeostasis
throughout the body and conserve energy
on an everyday occasion. This system is
usually known as the ‘rest and digest’
process. These processes include the
decrease in heart rate, increase in digestion
and secretion, stimulation of tears and
salivation, the constriction of pupils, and
the decrease in blood pressure. The energy
that is produced from the digestion and
other processes that are stimulated during
sympathetic reactions is then used to
restore and build tissues and store energy
(Low ND).

Reacting to an external stimuli and moving a muscle in response to the stimuli involves
the connection between the brain and the muscle through the transmission of nerves. The senses
of the body is what can originate muscle movement. These senses are detected by the sensory
neurons and sent to the brain, where a reaction is determined. From this, the information reaches
the muscle in order to create movement. The sensory pathway to the brain is where the impulses
move in order to connect the information. The process starts with an external stimuli. If a person
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steps on a lego and the sensory receptors beneath the skin detect pain, they begin the process of
transporting the signal to the brain in order to create a reaction. Starting at the sensory nerve, the
impulse shifts away from the nerve, and towards the spinal cord. In order to do this, it travels
across the synapse between the sensory nerve and the nerves within the spinal cord. To get to the
opposite side of the spinal cord, the signal of pain travels from the nerve cell of the spinal cord to
the other side. From this, the impulse moves up the spinal cord toward the thalamus, which acts
as the center for pain reception by receiving information given by the sensory nerves, by passing
through the brain stem. In order to get to the sensory cortex of the cerebrum, which main job is
to receive and interpret information given by sensory receptors, the signal travels through a
synapse in the thalamus to fibers that then transfer the signal to the sensory cortex of the brain.
The impulse is then interpreted by the sensory cortex and the person has the decision on how to
react to the external stimuli. If the person is burned, for example, they naturally would move,
which means that motor neurons would come and carry the impulse from the brain and to the
muscles (Rubin ND).
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2. What components of the nervous system are involved in the skeletal muscle movement?How
does motor impulse move throughout the body? What is a “motor unit”? (Maggie)
The nervous system is split up into two different divisions, central and peripheral. The
peripheral system’s main job is to carry signals to and from the central nervous system. Within
the peripheral nervous system, there is the somatic nervous system, and the autonomic nervous
system. The somatic nervous system is where skeletal muscle movement is found. It is made up
of nerves in the skin, sensory organs and, as said before, skeletal muscle. The somatic nervous
system is responsible for almost all voluntary movement of your body. When you lift your hand
to write, kick a ball, or move your fingers to type, you are putting your somatic nervous system
to work. Not only does your somatic system tell your body to move, it also takes the outside
sensory information, like hearing or sight, and processes it. The somatic nervous system is able
to do these things because it has two major neurons within it. Sensory and motor neurons
(Cherry, K. 2017).
A sensory neuron has one major job, to take the information from the outside, and inside,
and transfer it to the central nervous system. For example, if you touch a hot stove or pick up
your food before it cools, the sensory neurons
in your hand realize it is hot so they send
signals to interneurons that are in your central
nervous system and to tell your hand to put it
down. Motor neurons are on the outgoing side
of the interneurons. They take information
from interneurons and transfer that to the target
glands, muscles and organs. Interneurons main
job is to transfer the information received from
the sensory neurons, to the motor neurons
(ONS 2018). The picture to the right shows a
motor neuron. The blue branches that are
coming off the cell body are called dendrites. These dendrites help receive and collect signals
that are sent by the interneuron cells. Next is the axon, the long, yellow, string-like structure. The
axon is just like a cab. It receives the signals from one place and takes them to another. The blue
extensions from the axon with little buds on the end are the terminal axon buds. They connect to
the end plates of the neuromuscular junction, which are shown by the lighter red parts. The big
red bundle is a neuromuscular junction (LSFMN). Synaptic gutters are the places on the
neuromuscular junction where the bulb can reach closer to the end plates. Other parts of the
neuromuscular junction are the subneural clefts. Their main job is to create more surface area so
it is easier to receive the signal. Also, extra mitochondria is very visible in the picture below.
This increase of mitochondria occurs because of the extent of energy that is needed
(Neuromuscular junction 2018.)
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A motor neuron is classified as a multipolar neuron, meaning it has one axone but multiple
dendrites. The purpose for multiple dendrites is to receive as many signals as possible so your
body can then process them faster. This means it has one axon and is almost always long. The
axon needs to be long in order to connect to the neuromuscular junction.
Impulses are the signals that motor neurons send to the neuromuscular junction. When
impulses move, they go down a neuron pathway, as they move down this pathway they are being
electrically charged. This is happening because the ions that have moved across the cells neural
membrane are causing the impulse to move along the cells. Impulses are sparked by one neuron
invigorating another, or something that is in the outside word that will activate it. The impulse is
then received by the dendrites and sent down the axon, then reaching the terminal axon buds who
then transfer it to the neuromuscular junctions end plates, then finally the muscle is moved
(Nervous system 2018).
When there is only one cell body, one axon, and one neuromuscular junction, it is called
a motor unit. Many motor units are used in your body. For example, lifting weights. When you
lift the weight, multiple motor units are put into action and are making your muscles contract
(Neuromuscular junction 2018). So in conclusion, our body is very complex, but when you break
it down and focus on one detail it is much easier to understand the huge picture of what our body
can accomplish. For example, taking a big structure, like the nervous system, and breaking it all
the way down to a tiny piece, like the motor neurons, can really help understand how a basic
function works, like muscle movement.
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3. What movements are involved in the action of standing up? What muscles need to contract to
perform these actions? (Ciana)

a) Movements involved in in the action of standing up:

For us to be able to stand, there are many joint movements involved. Many muscles either
contract or relax to provide the force of the movement for the joints. The ankles and knee joints
are hinge type arculations, so they allow movement in one area. The quadricep muscles are in
charge of the knee movements. The soleus muscles in the calves control the ankle movements.
The hip is a ball and socket joint “where rounded head of a bone fits into the cavity of another,
allowing a rotational movement in any direction” Most of the hip movements are done by the
gluteus maximus.When you stand up, your hip joints extend or straighten so that your thighs
move backward while your knees extend and your ankles plantar flex as the interossei muscles
between the phalanges contract to provide stability and balance to stand, which means that your
feet point and move away from your shins. (Nunley K, 2017)
Muscles have the ability to contract due to thick filaments, consisting primarily of the protein
called myosin- which are arranged in a cylindrical shape, and thin filaments. In the process of
muscle contraction, the filaments (IvyRose Holistic ND ). There are different types of
contractions that the muscles in our legs have, either categorized as isometric or isotonic.
Isometric contractions are the ones where the muscle fibers remain the same while they are
undergoing pressure and produce force. Isotonic contractions are split up into two categories-
concentric and eccentric contractions. Concentric contractions happen when the muscles shorten
to generate force. Eccentric contractions occur when the muscles lengthen while giving force
(CFCH Coach 2017).

b)What muscles need to

contract to perform these
actions?
In order to
complete the action of
standing up, a lot of
muscles in both the
abdominal regions and
the lower extremities
either contract or relax.
Since the patient is a
young adult with no
other underlying illness,
we can assume that she
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doesn’t need her hands for support to stand.

Different muscles are involved in the action of standing, they all have different functions and
roles in the process. When muscles cause a limb to move through the joint’s range of motion,
they act in the following cooperating groups: The agonists are the muscles that give the most
force to carry out the action, it is the primary mover in the action. The antagonist is the muscle
opposite the agonist. It is not just situated opposite it, but it also does the opposite. While the
agonist contracts, the antagonist usually relaxes so that the ,or slows down the movementaction
wouldn’t be impeded. It also controls the degree that the agonist moves at, ensuring that no
damage is done to the joint and is responsible for returning the lim to its initial position. The
synergist is the muscle that stabilizes the joint where the movement is occuring, aiding the
agonist in proper movement. The fixator is the muscle that provide stability for the origin (where
the muscle joins the stationary bone) and the joint in which it spans over. They hold the body in
place while the movements occur.(Muscles and movement);(Muscle Roles and Contraction
Types)

The first movement we do

in the process of standing is
Bending forward, when the
body leans forward to get
into position for pushing
up.The groups of muscles
that coordinate with each
other for this motion are:
Agonists - Internal Oblique
and External Oblique
provide the major force as it
contracts to complete the
movement as it is centered
in the core of the body. The
antagonists are the
trapezius;while the internal
oblique contracts,the trapezius relaxes or slows down the movement,ensuring that there is no
damage done to the joints in the vertebrae. The Synergists -Latissimus Dorsi stabilizes and keeps
the intervertebral joints of lumbar lower thoracic vertebrae in place,helping the Internal oblique
to function properly Fixators -Rectus Abdominis ; they stabilize Thoracolumbar fascia and iliac
crest of the Internal oblique and the flexion of the vertebral column and stabilizes the lumbar
spine by creating tension through the thoracolumbar fascia.(Muscle Roles and Contraction types
2016) ; (Anatomy of Muscles in the Movements of Sitting to Standing 2014) ; (Muscle Roles and
Contraction Types.
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After leaning forward, the body then starts to push upward , a movement mainly done in
the legs; using these muscle groups: The agonists-tibialis anterior (Provides the source of
movement because most of the weight is now leaning forward). The antagonists-hamstring(while
the tibialis anterior contracts,the hamstrings help to slow down the movement, ensuring that
gravity doesn’t accelerate the movement) Synergists-Gastrocnemius and Soleus (they stabilize
the knee and aids the tibialis anterior with the movement). Fixators-Latissimus Dorsi stabilizes
the lateral condyle of the tibia (portion of the upper part of tibia that serves as the insertion for
the Biceps femoris muscle) and the knee, ensuring there is no damage done. (Muscle Roles and
Contraction types 2016) ; (Anatomy of Muscles in the Movements of Sitting to Standing 2014)
The final step is standing up. Your abs and obliques work together with your lower back
and glutes to help you rotate, balance and
stabilize the body during standing.The
groups used in the final action are:
Agonist:Gluteus Maximus contracts
concentrically- is the prime muscle in the
action of standing up as it spans across the
hips. Antagonist:Hamstrings- they relax
and slow down the movement done
primarily by the gluteus maximus .
Synergists:Gastrocnemius/soleus stabilize
the knees as the gluteus maximus provides
the upward movement.
Fixators:Thoracolumbar fascia stabilizes
the hips and base of spine (sacrum and
coccyx and back of ilium) while also
aiding the glutes in the motion.
(Anatomy of Muscles in the Movements
of Sitting to Standing 2014)
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4. What are the different levels of organization of a muscle down to myofilaments? What is a
“sarcomere” and how are its proteins organized? (Hannah)

The levels of organization refers to how all systems of the body connect and assemble
into larger structures, much like how a ecosystem works. Even the smallest units all work
together to create a complex anatomy in the body of a human. The simplest version of the
organization of life starts at a organism, then expands to a population, a community, an
ecosystem, biome, and then
lastly a biosphere. (ABI 2018).
The levels of organization of a
muscular system start with
myofilaments. These structures
generate force, which is the
reason muscles exert force to
allow us to move. Myofilaments
are the protein chains of actin,
myosin, and other peptides that
cause myofibers, a muscle cell,
to appear striated. Myosin is a
polypeptide, which is a protein
chain made up of amino acids
(Peptide 2014), that is mainly
used for the generation of energy
or force. The two heads of the peptide has sites for adenosine triphosphate (ATP), also known as
energy, production. Myosin also has two tails that are interwoven which are used for
polymerization, or the addition of amino acids to the chain (Myofilament Structure 2006). ​When
working with actin
filaments, Myosin creates
the energy used for force.
Together, they turn ATP
into mechanical energy thus
allowing the muscle to
contract and move (​Cooper
2000​). During contraction,
the actin-myosin complex
initiates. This is when the
myosin grabs ahold of the
actin filament. Once they
are somewhat interlocked,
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the myosin jerks on the filaments which creates a contraction to move. Tropomyosin is also
involved in the contraction of muscles. This protein helps the muscle contract when the muscle
does not (Chamberlain ND). Troponin is a protein that stimulates muscle contractions. There are
three types of this protein, troponin C, T, and I. “Troponin C ​initiates contraction by binding
calcium and moves troponin I so that the two proteins that pull the muscle fiber shorter can
interact. Troponin T anchors the troponin complex to the muscle fiber structure.” (Troponin
2015). Tropomyosin blocks contractions when the body is relaxed. When the muscle contracts
calcium is released into the sarcomere which causes. troponin displaces tropomyosin so it no
longer blocks the contractions. (​Harel M, Berchansky A, Hoeprich G, Prilusky J, Canner D,
Sussman J 2017​).
Myofibrils are what muscle cells are composed of. Myofibrils are cylindrical units of
thick and thin filaments, the thick filaments being myosin and the thing being actin. In muscle
cells, there can be hundreds of these myofibril strands. When the muscle contracts the filaments
within the myofibril slide against one another to produce ATP. Surrounding the myofibrils are
transverse tubules and the sarcoplasmic reticulum. Transverse tubules creates a pathway for the
action potential to hit the cell and cause a contraction, while the sarcoplasmic reticulum is where
calcium acetate is stored within the striated muscle cell. (SFSM ND). The University of New
Mexico explains “at points along the T tubules they attach to the sarcoplasmic reticulum, a
system of membrane channels inside the sarcoplasm. When the action potential moves along the
T tubules it causes the sarcoplasmic reticulum to release Ca+2 which is sequestered by the SR.
The SR pumps calcium like the sarcolemma pumps sodium and releases it into the sarcoplasm
when stimulated by the action potential.”
Muscle fibers (also known as muscle cells) are the next level of organization. There are
three types; smooth, skeletal and cardiac. Although for now, we are looking at skeletal muscle as
it is what causes organisms to be able to move. Skeletal muscle is any muscle connected to bone.
It is striated and strong as it is meant to withhold force. As stated before, they are made up of
hundreds of myofibrils. Also within the cell, there is the sarcolemma and sarcoplasm. The
sarcolemma is the cell membrane of this striated cell and the sarcoplasm, another word for
cytoplasm for this specific striated cell, fills holds the myofibrils and other organelles within the
cell. (MCSP ND). Within the striated muscle cell, there is a hemoprotein, a protein that deals
with iron and porphyrin (Hemoprotein 2012), called myoglobin. Myoglobin is located in the
sarcoplasm and stores the oxygen needed for cellular respiration (​Ordway G, Garry D 2004​).
But, striated skeletal muscle cells aren’t the only type of muscle fibers. There are smooth muscle
fibers, which are found in most hollow organs. There is also cardiac muscle found in and around
the heart (​Starkebaum G, Zieve D, Conaway B 2017​). A fascicle is a bundle of muscle fibers,
fascicles can come in the arrangements of circular, parallel, convergent, and pennate designs.
The design helps the muscle move to correlate with what part of the body it is located. For
example, circular fascicles are found around the mouth (MMFA 2014).
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The last level of organization is the

muscle itself. Just like the fibers, there are
smooth, skeletal, and cardiac muscle. Skeletal
muscle is part of the somatic nervous system,
meaning it is voluntary and we control how we
move it (Cherry 2018). Surrounding the
muscles is the connective tissue fascia which
secures muscles, blood vessels, and nerves
together. There are three layers of fascia, those
being superficial fascia, deep fascia, and
visceral fascia. “Superficial fascia is the fascial
sheet lying directly beneath the skin (eg, a
subcutaneous fat layer). Deep fascia is the most
extensive of the three kinds of fascia,
comprising an intricate series of connective
sheets and bands that hold the muscles and
other structures in place throughout the body”.
(​Lee S, Bin Joo K, Song S 2011​).
Subcutaneous fat is the layer of skin directly
below the dermis tissue. (​TLYS ND​). Also
surrounding the muscles is epimysium, a elastic tissue consisting of dense connective tissue. The
epimysium, along with perimysium and endomysium, connect the muscle to the periosteum of
the bones
(Epimysium
ND).
Perimysium is
what encases the
fascicle
(Perimysium
ND) and the
endomysium
encases the
muscle fiber
(Endomysium
ND). Muscle is
the last level of
organization of the muscular system, and the largest. All these structures make up the bigger
picture, they assemble into complex structures designed to perform a certain number of specific
tasks.
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SARCOMERE

A sarcomere is the smallest unit within a myofibril that is able to contract when the
muscle moves. In the myofibril, there is filaments that make
up the mass. The filaments, in a longitudinal section, have
low density bands called I bands. The I band appears light
under microscopic inspection. In between the I bands, there
are Z lines, or disks, which are dense. The space from one Z
line to the next is a sarcomere. There are also A bands
where thick and thin filaments overlap to create a dark
region. Also under the microscope, you can see bridge like
structures called cross bridges that run from thick to thin
filaments. They are believed to create movements and force
during a contraction of the muscle. In the center of the A
band, only where thick filaments are found, is the area
called the H zone. The H zone is lighter than the A band,
which also has a section called the pseudo-H zone. The pseudo-H zone is a light and narrow
section that does not contain any cross bridges like the H zone. “In the center of the A band is a
narrow, darkly stained region called the M band, in which occur fine bridges between the thick
filaments.” (Curtin N, Davies R, Walker W, Gergely J, Crompton R, Newsom-Davis J, Warshaw
D, Alexander R, Alpert N,Wood B 2017). The thin filaments, actin, attach to the Z lines of titin.
When the Z lines move closer together, the sarcomeres contracts, which causes the myofibril,
muscle fibers, and entire muscle to contract (MCSP ND). Titin is protein found within striated
muscle cells and spans from the Z disk to the M line. This forms a filament section in the
sarcomere, the third one. The filament is paramount for the structure and tension of a muscle
fiber when contracted (Labeit S, Kolmerer B, Linke W 1997).
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5. Starting from the release of acetylcholine by the motor neuron, what are the steps in muscle
contraction? How is contraction ended? (Levins)

Nerves have many jobs in the body, and one of them includes stimulating muscle
contraction. Muscle contraction allows us to stand up, pick up a box, reach for a door knob, and
so many other things that we don’t consciously think about; it’s one of the processes that our
brain automatically does for us. Muscles connect to our bones by processes, parts of bones that
stick out, so that when the muscle contracts or relaxes, it can move bones with it. The only way,
however, that the muscles can even do this is if signals are sent from the brain to motor neurons
that have end plates that sit right above the muscles. The signal released from the neuron then
triggers multiple stages of contraction and relaxation that involve so many moving parts of the
muscle cells. The cytoskeleton of the muscle cells is covered by myelin and includes microfibrils
that provide mechanical support and are made of microtubules, actin filaments, alpha and beta
integrins (receptors that stick outside of the cell membrane and attract to extracellular matrix),
mitochondria that serves as the source of ATP production for the myosin, ribosomes, the rough
endoplasmic reticulum, and the myofilaments actin and myosin (The Editors of Encyclopedia
Britannica 2013).
In the chemical process of muscle contraction, acetylcholine is the signal released into
synaptic clefts, small
areas on a chemical
synapse on a neuron
that is close to another
surface, the muscle in
this case. The chemical
is then released onto
the sarcolemma/
myolemma (the
sarcolemma is the thin,
protective layer that
holds in all of the
filaments in skeletal
muscle, and the
myolemma is the layer
around filaments in striated muscle), the surface of the muscle fiber that is about to contract. This
causes the membrane to be temporarily permeable to sodium ions. The sodium flood then causes
the membrane’s electric potential of the neuron’s end plate to be disrupted, causing an electrical
signal to be sent to the muscle cell’s sarcoplasmic reticulum, smooth endoplasmic reticulum that
regulates calcium ions. In effect of this, the action potential is then spread throughout the inside
of the muscle fiber through transverse tubules, tunnel-like tubes that pass through one side of the
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muscle cell to the other. Where the transverse tubules along the muscle fibers are in contact with
parts of the sarcoplasmic reticulum there is a release of calcium ions by the sarcoplasmic
reticulum that is triggered by depolarization caused by the release of the sodium ions (Meat
Science).
After the calcium ions are released, the two myofilaments, myosin and actin, are
incorporated; Actin is a protein that exists in two different forms; monomeric globular actin
(G-actin) and polymeric fibrous actin (F-actin). G-actin can be a free floating monomer, but can
readily polymerize as F-actin in movement conditions, such as contraction, as F-actin is the form
primarily involved in this process. Wrapped around the actin filaments and blocking their active
sites are the proteins troponin and tropomyosin (Ecochemistry 2018). In muscle, two strands of
actin filaments are intertwined to form filaments that sit between myosin filaments (The Editors
of Encyclopedia Britannica 2013), and to differentiate the myofilaments under a microscope the
actin appears much lighter than the myosin (Ecochemistry 2018). Myosin is made of long chains
called tails, and a center at the M line head that flows polar. Myosin is made of adenyl
pyrophosphatase (ATPase) enzymes
created to catalyze ATP into usable
ADP and phosphate (Sal Khan
2018). When the calcium ions are
released by the triggering of
depolarization, they then bind to the
troponin, and this displaces the
proteins that are covering the
binding site, exposing the myosin
binding sites along actin filaments.
When forming cross-bridges at the
troponin binding sites on the actin
strands, the ATP molecules and
phosphate ions bind to the myosin binding sites, leaving the binding sites exposed (Alila Medical
Media). When the ATP binds to myosin head, the myosin releases actin to release the head from
the binding site. When the myosin head is released, the ATP is hydrolyzed and phosphate is
dropped (Sal Khan 2018). This causes potential energy to build up in the myosin head and, as the
myosin heads are highly polar, they attach to an active site on the actin in a spring-like action.
This pulls the actin filament along the thick myosin. An ATP molecule then binds to the myosin
head’s active site and reacts with water through ATP hydrolysis, then the attraction, or
cross-bridge, of the actin and the myosin is broken (Meat Science).
To go in more depth, in the ATP hydrolysis reaction, one molecule of water reacts with
one ATP and a catalyst to yield an ADP which holds about 7kcal/mol of energy, but only about
40% of that is used in the muscle contraction process, as the rest is lost as heat energy (Visible
Body 2017). In this, the phosphate is dropped, and in the movement of the myosin heads moving
 16

the actin filaments along, the stored energy (the 40%) is used and ADP is released, and ATP is
placed on the myosin head, causing it to release from the binding site (Alila Medical Media
2016). The newly attached ATP molecule on the myosin head then breaks down into ADP and
phosphate by a reaction in the ATPase in the myosin head, and the energy released by this
reaction is then stored in the
myosin head. Here, the
myosin is ready for another
cycle, and after the actin
filaments have been moved
through a few cycles, as
they are pushed along, the
length of the sarcomere is
shortened (Alila Medical
Media 2016). At the start of
each binding cycle, the
myosin swivels and moves
to the next active site on the
actin filament, pulling it
even further along the
myosin myofilament. As the
myosin continues to pull the actin filaments closer to the center of the sarcomere, the M line,
shortening the I band and the H zone, the muscle cell shortens in length (Meat Science). The
cycles will continue as long as the calcium ions are still present on the actin filaments, but once
the flow of acetylcholine stops, the calcium ion flow will cease, therefore stopping the cycles
from continuing, allowing for the relaxation process to start (Alila Medical Media 2016).
Hugh Emerson Huxley created an explanation for the this shortening process in which the
thick myosin filaments and the thin actin filaments slide against each other in a fashion that
shortens the length of
the muscle sarcomeres
that make up the
muscle fibers. He
named it the Sliding
Filament Theory. In
the sliding of the
filaments, ATP binds
to the myosin heads
and breaks the
cross-bridge between
the myosin and the
 17

actin. Similar to rowing a boat because this process moves the actin filaments along to shorten
the muscle fibers. When the actin filaments are pulled along by the myosin, it shortens the
sarcomere because the actin is anchored to the Z lines, so it drags the Z lines with it, creating that
‘shortening sarcomere’ factor (The Editors of Encyclopedia Britannica 2018b).
Once the muscle is then contracted, it is then relaxed by the breaking down of
acetylcholine by acetylcholinesterase, enzymes at the neuromuscular junction where the
acetylcholine is released into the muscle cell. This stops the release of calcium ions, which
triggers the cycles of sliding filaments, from continuing along the muscle fiber. It then begins to
sequester all the previously released calcium ions, returning them to the SR terminal cisternae.
When the calcium ions are taken away, the flow ceases to continue, causing the troponin and
tropomyosin to return to the binding site and prevent the myosin from binding to the actin
filaments, causing the cross-bridge formed by the actin and myosin attraction to end, and
magnesium ion clumps are then formed with ATP, and the sarcomeres return to the relaxation
state where the actin returns to its original place, finally finishing the process of muscle
relaxation (Meat Science).
 18

6) Are Kathy’s medical problems related to her sensory neurons, motor neurons or, or both?
What in Kathy’s medical history supports your answer? (Group)

Kathy’s medical history shows that her medical problems are related to both her sensory
and motor neurons. As a 20 year old woman, Kathy has been through a number of medical issues
in the past year. She has experienced an awakening to a numbing sensation in both of her feet,
and a loss of hearing in her right ear. The sensory neurons are in charge of transporting
information from the skin and muscles, to the spinal cord and brain and monitor the body’s
internal and external conditions These neurons work with the motor neurons in order to control
mobility and reactions. Her sensory and motor neurons are affected, shown by the numbness in
her legs as well as her sudden hearing loss and the fact that she was unable to feel a cut on her
knee. Symptoms of damaged sensory neurons include numbness, tingling/prickling feeling,
problems with positional awareness. Motor neurons are used to receive the sensory signals and
make the muscles move. We believe that the motor neurons were affected also because when she
tried to engage her leg muscles, they did not respond and she fell to the ground (ONS 2018).
The origin of this hearing loss is unknown, but we do know that hearing depends on
sensory neurons. This action begins in the cochlea of the inner ear. The cochlea is a spiral
structure that produces nerve impulses in response to sound waves. This gives people the ability
to hear. In this, there are sensory hair cells that detect sound signals through sensory neurons.
Once sound is detected, it is transmitted to the CNS by the spiral ganglion neurons, which are a
group of cells within the cochlea thats main function is to send a representation of sound from
the cochlea to the brain. The spiral ganglion neurons link the hair cells in the cochlea to specific
neurons within the brainstem (Appler, Goodrich 2011). Hearing loss occurs when there is
damage to the inner hairs or the nerve cells. This can occur from excess noise, or it can be a side
effect of certain diseases such as meningitis, multiple sclerosis, etc (Raphael, 2002). From this
information, we can infer that she had a case of sudden sensorineural hearing loss, which is
damage within the hair cells in the cochlea or damage to the cochlear nerve, which has the
function of connecting the sensory neurons of the cochlea to the neurons in the cerebral cortex
within the CNS (Appler, Goodrich 2012). This type of hearing loss can be treated with steroids.
The use of steroids is thought to reduce inflammation and swelling within the organs of the ear.
She took steroids for her hearing loss, which resulted in her ability to hear again. Even though
the steroids did indeed help her hearing, it is proven that they can have an effect on dopamine.
Dopamine is a neurotransmitter in the body that helps with many things, such as mobility. When
she tried to stand she fell to the ground, and couldn’t move her right leg, so we believe that her
steroid intake could have been a factor in the effect of damaged motor neurons in her body,
which gives her the ability to stand (Kailanto ND).
Motor neurons in the body have the function of transmitting signals from the brain and
spinal cord to the muscles in order to carry out reactions and movements. When there is a
problem occuring with the motor neurons in the body, it is possible that there is a motor neuron
 19

disease (MND) present. MDNs are disorders that kill motor neurons progressively by
interrupting the communication between the neurons and the muscle. This disruption causes the
muscles to become weak over time and may begin to twitch uncontrollably as well as become
stiff and create movements that are slow and not easy to complete. It is possible that Kathy is
experiencing a motor neuron disease due to the fact that she has had many different instances
throughout the year where she has experienced unusual motor uncontrollability. The morning
that Kathy was unable to get up, a few things were observed. Both of her legs were weak and
unable to support her weight on order for her to get up from the ground and she had a cut on her
knee that she could not feel at all. With this information, we can assume that the sensory and
motor nerves in her legs were severely damaged, due to a sensorimotor disease (NINDS, 2017).
 20

7. What is myelin and how does it affect the transmission of nerve impulses? Identify the cells
responsible for the formation of myelin. (Autumn)

The motor activities that the body performs on a daily basis are controlled by nerve cells
administered by the brain. The nerve cells that send signals to the brain in order to carry out
motor functions have a tight, protective coating over the axon called myelin. The axon is a nerve
fiber that’s main function is the transmission of electrical impulses from the cell to receptor
neurons, muscles, and glands. The myelin coating provides insulation and protection to the axon
as well as the enhancement of the transmission of electrical impulses. Myelin is made out of
around 40% water. The dry mass of myelin is made out of 80% lipids--mainly the glycolipid
named galactocerebroside (GalC), and 20% protein. The proteins found within the myelin are
myelin basic protein (MBP), ​ proteolipid protein (PLP), and myelin oligodendrocyte
glycoprotein (MOG). In order for the myelin sheath to become strong and sturdy, hydrocarbon
chains made of sphingomyelin are cross linked within the myelin (Robertson, 2015)
Myelin is made and used in the Central Nervous System and the Peripheral Nervous
System. When there is a disruption or damage to the Myelin, however, it only affects the Central
Nervous System. The myelin produced in the CNS is made out of oligodendrocytes. The myelin
produced in the
PNS is made out
of Schwann cells
(National
Multiple
Sclerosis Society,
ND).

The main
function of
oligodendrocytes
is to provide insulation to the axons as the multiple layers of the cells around the axons form the
myelin sheath. The length of a single oligodendrocyte is so long that it can wrap around 50
axons, wrapping 1 micrometer of myelin sheath around each axon. Damage to the
oligodendrocytes can lead to diseases like multiple sclerosis, which is a disease in which the
body’s immune system attacks the central nervous system by damaging myelin, resulting in
symptoms such as numbness, muscle spasms, difficulty moving limbs, etc. It can also cause
leukodystrophies, a group of rare and progressive diseases that affect the brain, peripheral
nerves, and spine; spinal cord trauma, and cerebral palsy, which is the loss of motor function
usually caused by brain damage (Kirkwood, 2015).
 21

Schwann cells perform the function of the creation of the myelin sheath by wrapping
around the axon. These cells can only wrap around one axon at a time, however, there are two
different types of Schwann cells: myelinated and unmyelinated. A myelinated neuron is a cell
that’s axon is covered with myelin sheath, and its nerve impulse is faster. An unmyelinated
neuron is a is when the axon is not covered by a myelin sheath, which makes the conduction of
the impulse slower (Adikorocagi, 2017). Damage to the Schwann cells can lead to
Schwannomatosis, which is a rare genetic disorder that results in the growth of tumors on the
peripheral nerves; Leprosy,which is a slowly developing disease causing damage to the skin and
the peripheral system; and chronic inflammatory demyelinating polyneuropathy (CIPD), a
neurological disorder that
causes impaired sensory
function in the legs and arms
(Kirkwood, 2015).
When it comes to the
process of transmission of
impulses, the myelin plays a
big role in enhancing this
function. The myelin is
structured in a specific way
that is catered to speed up the
transmissions. As the myelin
is wrapped around the axon, it
creates small gaps, called
nodes of Ranvier. Thes gaps
provide a resource for the
impulse to travel faster. The
impulse jumps on each gap,
giving them a space that is not
too far to move when the action potential is occurring. This lets the impulse travel at a much
faster pace rather than if it had to travel along the entire nerve fiber (Robertson, 2014)
 22

8. What are the “scleroses” in Multiple Sclerosis and where do they occur? How does this
influence nerve transmission? (Ciana)

Multiple Sclerosis is an autoimmune disease (in which the body produces antibodies that
attack its own tissue, leading to deterioration or destruction of the tissue) of the brain and spinal
cord that causes many symptoms,the most common being vision loss, pain, fatigue, and impaired
coordination.The name “Multiple Sclerosis” refers to the multiple scars on the myelin sheaths.
Sclerosis is the hardening of a tissue especially from overgrowth of fibrous tissue or like in this
case, an increase in interstitial tissue(Sclerosis). Multiple sclerosis affects the neurons in the
brain and spine that are in control of carrying information and control the body. In multiple
sclerosis, the myelin sheath- which is a fatty white substance that surrounds the axon of nerve
cells that form an electrically insulating layer, is destroyed with inflammation and scarring in a
process called demyelination- as shown in the picture below. Demyelination causes scarring and
hardening (sclerosis) of nerve tissue in the spinal cord, brain and optic nerves while slowing
conduction of nerve impulses.In
MS, demyelination occurs in the
white matter of the brain and in
the spinal cord. The white
matter connects different
regions of grey matter in the
cerebrum which allows quick
passage of messages through
neurons.This is possible because
of the electrically insulating
myelin sheaths (Balm, James
2014).When people have
MS,the body’s immune system
mistakenly attacks the
insulation around myelin
(Multiple Sclerosis 2018);
(Multiple Sclerosis:Medicine Plus ND); (Autoimmune Disease ND).
There are two types of tissues involved in the degeneration of myelin- T and B cells. A
blood-brain barrier formed by blood cells which prevents materials in the blood from entering
the brain. It allows the exchange of oxygen, carbon dioxide while preventing pathogens from
entering the brain. and other nutrients B cells are a type of white blood cell and a type of
lymphocyte that produce antibodies/proteins necessary to fight off infections. T cells are a type
of lymphocyte produced and/or processed by the thyroid glands that destroy threats to the body.
In MS, T and B cells get into the spinal cord and brain. Demyelination starts when B cells
recognize myelin and send signals for T cells to attack it.
 23

T and B cells then release chemicals that attract other immune cells (represented by the red dots),
causing inflammation to the myelin.

The B cells produce antibodies that attack myelin and get help from other immune cells.

Depending on the severity, some T and B cells may inhibit the nervous system permanently
continuing the cycle. (Genentech ND)After demyelination, the loss of myelin is often replaced
by scar tissue, and that is what the “scleroses” are in MS. Scar tissue can block the formation of
new myelin and axons don’t
fully regain their function
because they become
scarred (Jones, Paul ND).
It directly influences nerve
transmission because nerves
need the insulating coat of
myelin in order to function
properly. Nerves have a long
thin fiber that transmits
electrical impulses. They
allow signals to be passed
around distant parts of the
body like the leg muscles, spinal cord and brain. Nerves are surrounded by myelin sheath that
 24

helps speed up the impulses. In between the myelin there are gaps called nodes of Ranvier. By
jumping from node to node, the signals conduct quickly and more efficiently across the fiber. As
myelin is destroyed, the central nervous system loses some of its ability to send signals
throughout the body. In a normal and healthy nerve, the information is transported quickly, but
in the sclerosis damaged nerve, the message is either slowed down or doesn’t get received.
Multiple sclerosis has its most evident effects on motor and sensory neurons-which normally
have longer axons transporting information between the brain, spinal cord and other areas of the
body. Because they are long, they have a greater need for insulation of myelin and is therefore
destructed the most in the loss of myelin. Some of the most common symptoms is shown in
Kathy which are gait problems, sensation loss and motor reflexes(Britanica 2016); (Multiple
Sclerosis 2018).
 25

9. How do an MRI and spinal tap help confirm the diagnosis of Multiple Sclerosis? (Levins)

Spinal taps, sometimes called lumbar punctures, are necessary for identifying pertinent
bacterial infections, hemorrhages in the brain, cancers in the nervous system, and inflammatory
conditions like multiple sclerosis (Mayo Clinic Staff 2018). In most spinal tap procedures, the
patient is laid on their side with the legs and hips flexed, also called the fetal position. The doctor
performing the procedure then finds the correct location
on the spine, often done by locating the top of the pelvis
which is in a known proximity of the fourth and fifth
lumbar vertebrae. A numbing medication, lidocaine, is
then injected into the tissues of the lumbar area. Once the
numbing sensation has taken over, the needle is then
inserted between the fourth or fifth lumbar where spinal
fluid sits (Fell 2017). Cerebrospinal Fluid (CSF) is the
fluid that surrounds the brain, spinal cord, and in between
vertebrae. It serves as a shock absorber, and it circulates
nutrients from the blood while removing waste that
comes from the brain. When a spinal tap procedures are
performed on MS patients in diagnosis, the CSF would show: high levels of Immunoglobulin
antibodies (which are present when fighting off infections), the presence of oligoclonal bands
(proteins that suggest inflammation), and breakdown products of myelin (National Multiple
Sclerosis Society Staff 2).
MRI’s, or Magnetic Resonance Imaging, provides images of different parts of the body
that are hard to see without being extremely invasive. MRI’s used magnetic waves to measure
the relative water content in
all kinds of tissues found in
the body, including those
that are not supposed to be
there. The strength of the
magnetic fields causes some
of the hydrogen protons in
the H2O molecules to line up
toward the magnetic field’s
origin. When more magnetic
radio waves are sent, the
protons get knocked around,
but when the waves cease
they fall back into line. When they do, they emit resonance signals. Doctors can see
 26

abnormalities by looking at the myelin, the fatty layer around nerve cell fibers, which act
superhydrophobic toward the water in tissue. When myelin is damaged, there is less fat, which
means that more water is able to be held in that area. Since MRI scans show water in the tissue,
doctors can see this damage when there is excess water in abnormal places. When diagnosing
MS, it is most useful to use an MRI at the beginning when the patient is still in the CIS
(Clinically Isolated Syndrome) stage where the first occurrences of neurological symptoms are
identified. At this time, doctors can find the lesions, which have been absent in 5% of cases
during the CIS stage, to prevent further damage.
There are multiple types of MRI scans that help to identify different kinds of damage in
sensitive tissue. A T1-weighted scan uses the injection of gadolinium to highlight areas of
inflammation; gadolinium has too large of molecules to pass through the barrier between the
blood and the brain, but where there is inflammation, the gadolinium is able to enter the nervous
system and highlight the disruption. T2-weighted scans held find lesions, as previously
mentioned, and FLAIR (fluid attenuated inversion recovery) methods are used to specifically
look at lesions associated with MS because the syndrome includes both lesions and
inflammation. Finally, spinal cord scans help to diagnose MS by showing the damage done to the
spinal cord over time, not just at one point in time (National Multiple Sclerosis Society Staff 1).
 27

10. Why did steroids help alleviate Kathy’s symptoms? (Hannah)

Corticosteroids, also known as steroids, are drugs that are used to reduce inflammation.
Unlike anabolic steroids, which are used to build muscle mass, corticosteroids are used mainly
for medical uses to treat certain diseases (TMS 2017). Multiple Sclerosis is a debilitating disease
of the brain and spinal cord. The causes of multiple sclerosis (MS) is traced back to the immune
system, where it attacks the myelin sheath of nerve fibers as if
they’re foreign bodies. The range of effects of MS varies due to
nerve damage, causing some to lose the ability to walk, hear, or
see. Although MS cannot be cured, the episodes can be treated to
prevent further damage to nerves. (Mayo Clinic Staff 2017).
In most cases, a certain steroid called Methylprednisolone
is used to treat the symptoms and relapses involved in multiple
sclerosis. Although some episodes do not need medication and
can heal with time, intense relapses can gradually healed with the
steroid. Depending on how intense the relapse is, the dosage is
higher or lowered to accommodate the bodies needs. This steroid
works by subduing the immune system from attacking cells in the body.
Methylprednisolone also reduces swelling surrounding the nerve as the swelling can
damage the nerve further (SM 2017). Some other steroids used during relapse periods are
Solu-Medrol and Decadron. These steroids are given at treatment centers and require blood to be
drawn (TMS 2017). Corticosteroids works by reducing inflammation
caused by the body's white blood cells to protect the body against
infections and invaders (Corticosteroids 2015). There are two main
ways that the steroids subdue the immune system, either by
suppressing T or B cells. T-cells are involved in the response of the
immune system, by stifling the production of cytokines, and can
ultimately control the overall actions of the system. B-cells create the
antibodies that the immune system attacks cells with. When the b-cells
are unable to create these antibodies, damage to nerve cells is virtually
impossible for a temporary amount of time (Krafts K 2010). Chemicals
can protect against infection and foreign substances such as bacteria
and viruses. With MS, the inflammation can further damage the nerves by irritating the body’s
tissues (Corticosteroids 2015).
By reducing inflammation and suppressing the immune system temporarily, the steroids
alleviate the symptoms that Kathy had been enduring during her episode of MS. Specifically,
suppressing the immune system would allow Kathy to temporarily regain her full hearing and the
sensations in her legs. Therefore, the alleviation of these symptoms would justify her use of the
steroids to treat Multiple Sclerosis.
 28

11. How does Copaxone work as treatment for Multiple Sclerosis? How do other types of
medications differ? (Maggie)

Multiple Sclerosis,
also known as MS, is a disease
that occurs when the
myelinated axons of a neuron
have been destroyed, as shown
to the right. If the myelinated
neurons are destroyed, it can
lead to hardening of the
certain, targeted tissue (Davis
CP. 2018.). There are multiple
medications that have been
proven to treat MS, but most
have serious side effects or they don’t work as well as others.
One of the most popular medicines for MS is Copaxone. Copaxone is taken in the form
of injection so it can get into the body faster. It is a mixture of four amino acids that are in
Myelin that are missing along the axon due to MS. These four amino acids are L-glutamic,
L-alanine, L-lysine and L-tyrosine. The mixture of these help recreate the myelin that is needed
along the axon, keeping inflammation in check (Dutt S. 2013.). Copaxone also helps MS by
redirecting signals from
the cytotoxic T-cells and
sending more Helper
T-cells into the damage
site. T-cells are a type of
white blood cell that help
fight off diseases.
Cytotoxic T-cells are white
blood cells that physically
attack the infection, helper
T-cells send the signals to
the cytotoxic T-cells to
attack the “intruder”
(T-Lymphocytes, 2018).
This stops the cytotoxic
T-cells from destroying the
myelinated neurons and
 29

increase the destruction of MS. Once the helper T-cells are sent into the central nervous system,
they then release proteins that help stop the cytotoxic T-cells that are at the “damage site.” The
picture to the above shows a person who has MS, and how the myelin is being attacked by the
cytotoxic T-cells. In Copaxone, there are much more helper T-cells circulating in the
bloodstream. Not only in the bloodstream, but they would also at the damage site, which is
shown in the top box. They are sent to the damage site to try and relieve the damage that is being
done by the cytotoxic T-cells (confused T-cells) and tell them to stop destroying the Myelin and
that it is not a infection (Copaxone: Multiple Sclerosis, ND).
This makes Copaxone stand out more than it already does, considering it is one of the
most popular medicines for MS. For example, the medicine Interferon is used for MS and
multiple cancers (Interferons vs. Copaxone, 2014). The way that this medicine works is it boosts
the immune system​,​ helping increase the number of white blood cells, fibroblasts, and natural
killers. This way has been proven to work, but not as well as Copaxone. When Interferon is
compared to Copaxone, it has much lower rates of stopping progression, and also many more
relapses (Williams E. ND). Another medicine that Copaxone is compared to is Aubagio. This
medicine is taken orally, which differs from the injection way of Copaxone. Aubagio also helps
“deactivate” the cells that are causing the destruction of Myelinated neurons.
So in comparison, Aubagio tries to only stop the pro-inflammatory cells, while Copaxone
not only tries to stop the pro-inflammatory cells, but also send in more anti-inflammatory cells to
help with the destruction that has already occured (Aubagio, 2018). Also, Copaxone has mild
side effects compared to other medications. Some of the worst side effects that occur while
taking Copaxone are a sore throat and swollen feet (Cunha JP. 2017). Other medicines for MS,
such as Interferon, have side effects such as a low white blood cell count, as well as increased
heart rate (Multiple Sclerosis, 2017). All of these medicines do their job, help MS by stopping
the destruction of the myelinated neurons. Copaxone differs from the rest of the medicines
because of how it executes the problem.
 30

12. Why did Kathy experience the altered sensation in her lower body? Was there something
wrong with her skin? Why couldn’t she stand? Was there something wrong with the muscles of
her right leg? ​(​Ciana and Autumn)

Throughout the year, Kathy has experienced tingling and numbness within her feet to her
knees, up until it reached the midline of her body. This was prior to the sense of paralysis and
weakness in her legs, creating the inability to stand. This occurrence of progressive abnormal
feelings or lack of feelings show a disturbance in her normal nerve functions. The loss of feeling
in the feet and legs, as well as balance and the ability to walk normally are characteristics of
sensory ataxia. Sensory ataxia is a loss of coordination due to the damage of sensory and neuron
cells responsible for sending signals from the outside of the body to the brain and spinal cord,
and from the spinal cord to the muscles and tissues. Symptoms of sensory ataxia include
irregular gait, or the way in which an individual walks, and the inability to keep balance,
especially when the eyes are closed. This is due to the loss of proprioperception, or the ability to
locate parts of your body in relation to your body as a whole and the position of the environment.
This type of ataxia is both a symptom and a sign of a greater problem taking place in the nervous
system, such as Multiple Sclerosis (Nordqvist, 2017); (Angelini C, 2014)
Kathy’s inability to stand is likely to be a symptom of Multiple Sclerosis. Multiple
Sclerosis causes lesions in the brain and spinal cord that in turn affects the myelin by
demyelination. Demyelination is a form of damage to the nerves which causes scarring and
hardening of nerve tissue in the spinal cord, brain and optic nerves, slowing the conduction of
nerve impulses (Balm, James 2014). As she was unable to stand, she attempted to lift herself up
using her right leg, resulting in a drop in the leg due to its inability to hold her weight. As her
right leg gave up, it was unable to contract the muscles needed to carry her weight. This is a
symptom of Multiple Sclerosis. This disease damages the pathway of nerves from the brain to
the spinal cord to the muscles, inhibiting the transmission needed to contract the muscles. This
resulted in her inability to stand, or use her leg to lift herself up. (Movement Disorders / Gait
Ataxia,2011) ; (Angelini C, 2014).
Multiple Sclerosis affects many different aspects of the body, including the skin. This
disease causes symptoms of abnormal sensation in the skin such as numbness, tingling, and a
feeling that there is something in contact with the skin, such as water or pressure, when nothing
is there. Numbness can be caused by everyday experiences such as crossing your legs, or falling
asleep on your arm. However, Kathy had a returning numbness and tingling in her feet that
progressed up into her midline in a matter of months. This muni ness would take a few days up
to a week in order for her legs to regain full feeling. The recurring numbness presented a sign
that there was a disturbance in something within her CNS, which indicated that she needed
medical help (Cassata, 2017).
 31

13. Did Kathy’s hearing loss have anything to do with the Multiple Sclerosis? Why/Why not?
(Maggie, Levins, and Hannah)

Kathy’s hearing loss was an early symptom of her soon to come Multiple Sclerosis, when
she was at her early CIS stage (detailed in question #9). During the Clinically Isolated Syndrome
course of MS, one can expect to experience numbness in the limbs, occasional blurry vision,
muscle weakness, vertigo, and muscle pain or tenseness. CIS is caused by myelin damage which
disrupts and prevents the sending of signals from nerves. This, in turn, causes the mentioned
symptoms. These symptoms can pursue for approximately 24 hours, and often more. These
symptoms are so similar to those of Lyme disease and strokes that, in order to diagnose MS
completely, doctors need to use an MRI or spinal tap so to not
mistake MS for the others (WebMD Staff 2017).
With MS, it is very rare to experience hearing loss as
the first symptom noticed. Medication can reduce inflammation
which restores the hearing that was nonfunctioning. MS works
by destroying the myelin sheath around the nerve cells. The
loss of hearing is caused by scarring and inflammation of the
auditory nerve, or when plaque develops where the myelin was
once located. In this case, Kathy was very lucky to catch her
MS, although it’s tremendously rare, as deafness can occur if
the damage becomes too extensive to repair with medications.
Only about 6% of all with MS experience hearing loss, which is why her symptoms cause was
strenuous to pinpoint (Hearing Loss 2018).
Kathy had experienced hearing loss before her foot and leg began to tingle and become
numb daily. We are able to hear because vibrations from the sound made hit the little hairs in our
cochlea, then the cochlea sends electrical signals to the brain. When these signals hit the auditory
neurons of the brain, they start to decipher the vibrations into sounds that we know (HBPAS,
2013). Multiple Sclerosis rarely causes deafening effects, but it can happen. Since MS is a
disease that occurs when the myelin along the axons of neurons become demolished, this shows
that the MS has been affecting the auditory neurons in Kathy’s brain that are responsible for
receiving and deciphering the vibration signals (Multiple Sclerosis, 2018). When a person
experiences hearing loss due to MS, the hearing is almost always able to be brought back. Since
Kathy’s hearing was able to be brought back with the help of steroids, it can be concluded that
the reason she underwent hearing loss was an effect of the early-set Multiple Sclerosis. This
partial deafness acts as a “warning” to MS, and since Kathy had this hearing loss before she
could no longer stand on her leg, it provides more evidence that her hearing loss is connected to
her MS (Hearing loss, 2018).
 32

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