ANATOMY AND

PHYSIOLOGY OF THE
NEUROLOGIC SYSTEM

STRUCTURAL CLASSIFICATION OF
THE NERVOUS SYSTEM
1.CENTRAL NERVOUS SYSTEM
Brain
Spinal Cord
2.PERIPHERAL NERVOUS SYSTEM
Spinal Nerves
Cranial Nerves

FUNCTIONAL CLASSIFICATION OF THE

NERVOUS SYSTEM :
1. SENSORY or AFFERENT DIVISION
Conveys impulses to the CNS
Consists of :
Somatic Sensory Fibers
Visceral Sensory Fibers or
Visceral Afferents

FUNCTIONAL
CLASSIFICATION
OF
THE
NERVOUS SYSTEM
2. MOTOR or EFFERENT DIVISION
Carries impulses from the CNS to the
effector organs
Consists of:
Somatic Nervous System or Voluntary
Nervous System
Autonomic
Nervous
System
or
Involuntary Nervous System
a. Sympathetic Nervous System
b. Parasympathetic Nervous System

Sensory Pathways

Motor Pathways

Neurotransmitters
Acetylcholine
Used by somatic motor neurons
Inhibited and inactivated by
acetylcholinesterase

Neurotransmitters
Catecholamine
neurotransmitters/Monoamines
Stimulatory effect
Inhibited by neurotransmitter reuptake,
presynaptic degradation (Monoamine
Oxidase) and post synaptic degradation
(Catecholamine O-Methyltransferase
Stimulated by MAO inhibitors and
SSRIs

Neurotransmitters
Catecholamine
neurotransmitters/Monoamines
Dopamine
Epinephrine
Norepinephrine
serotonin

Neurotransmitters
Glycine and Gamma-Aminobutyric Acid
(GABA)
inhibitory neurotransmitter
inhibits the activity of spinal motor
neurons thus helping in the control of
skeletal movements
Acts as a general inhibitory
neurotransmitter in the brain, and is
often used as a tranquilizer (e.g. the
drug : Benzodiazepine Valium ), for
mood and emotion disorders

Neurotransmitters

Endorphines & Enkephalins

Helps to block the transmission of pain
and also provide pleasant sensations
endogenously produced morphine-like
substances

CRANIAL NERVES
Name / Number

Composition & Function

I - Olfactory

Sensory - Olfaction

II - Optic

Sensory - Vision

III - Oculomotor

Motor - innervation to the inferior

oblique, superior, inferior &
medial rectus muscles of the eye
Motor eyelid
Motor muscles that regulate the
lens shape and pupil size

IV - Trochlear

Motor superior oblique muscle

of the eyeball

CRANIAL NERVES
Name / Number
V Trigeminal
Opthalmic Nerve
Maxillary Nerve
Mandibular Nerve
VI - Abducens

Composition & Function

Sensory impulses from cornea,
skin of nose, forehead and scalp
Sensory impulses from nasal
mucosa, upper teeth and gums,
palate, upper lip and skin of cheek
Sensory muscles of mastication
Motor muscles of mastication
Motor lateral rectus muscle of
the eyeball

CRANIAL NERVES
Name / Number
VII - Facial

Composition & Function

Motor muscles of facial

expression, lacrimal and salivary
glands
Sensory taste buds of anterior
tongue,
nasal
and
palatal
sensation
VIII - Vestibulocochlear Sensory impulses associated
with equilibrium and hearing
IX - Glossopharyngeal

Motor muscles of the pharynx

that
promote
swallowing,
salivation of parotid gland
Sensory taste buds of posterior
tongue and carotid artery

Name / Number
X - Vagus

XI - Accessory

Composition & Function

Motor muscles of pharynx (swallowing)
and larynx (Phonation)
Motor visceral activity: digestive tract
and regulates heart rate
Sensory taste buds of rear tongue,
auricle of the ear and general visceral
sensations
Motor Laryngeal movement, soft
palate
Motor & sensory sternocleidomastoid
& trapezius muscles

XII - Hypoglossal Motor tongue movement

Sensory muscles of the tongue

CN

DYSFUNCTION

INTERVENTIONS

Decreased sense of smell

Is often accompanied by impaired taste and weight

loss

II

Decreased visual acuity and

visual fields

Frequent reorientation to environment. Position

objects around client in deference to visual
impairment

III Double vision (diplopia)

IV,V
I

Intermittent eye patching

Lubricate eyes to protect against corneal abrasions

Decreased facial sensation

Inability to chew
Decreased corneal reflexes

Caution in shaving and mouth care. Choose easy to

chew foods with high caloric content. Protect
corneas from abrasion by using lubricant

VII

Facial weakness and

decreased taste (anterior
tongue)

Oral hygiene. Account for decreased food intake.

Cosmetic approach to hiding facial weakness.

CN

DYSFUNCTION

INTERVENTIONS

VIII

Hearing loss, imbalance,

vertigo, tinnitus

SAFETY!
Move slowly to prevent nausea and emesis. Assist
ambulation

IX
X

Dysarthria, Dysphagia,
cardiac and respiratory
instability

Maintain airway.
Prevent aspiration. Swallow therapy

XI

Inability to turn shoulders or

turn head from side to side

Mobility aids. Physical therapy

XII

Dysarthria, dysphagia

Maintain airway.
Prevent aspiration. Swallow therapy

SPINAL NERVE PLEXUSES

Result if
Damaged

Plexus

Important
Nerves

Cervical

Phrenic

Diaphragm and
muscles of the
shoulder & neck

Respiratory
paralysis

Brachial

Axillary

Deltoid muscle

Radial

Triceps & extensor

muscles of the
forearm

Paralysis and
atrophy of the
deltoids
Wristdrop
inability to extend
hand at the wrist

Median

Flexor muscles of the

forearm

Inability to pick up
small objects

Ulnar

Wrist & hand muscles

Clawhand
inability to spread
fingers apart

Body Areas Served

Plexus
Lumbar

Sacral

Important
Nerves

Body Areas Served

Result if
Damaged

Femoral

Lower
abdomen,
buttocks,
anterior
thighs and skin of leg
and thigh

Obturator

Adductor muscles of
thigh and small hip
muscles, skin of thigh
and the hip joint

Sciatic

Lower
trunk
and
posterior surface of
the thigh and leg

Inability to extend
hip and flex knee

Fibular

Lateral aspect of leg &

foot

Footdrop

inability
to
dorsiflex the foot

Tibial

Posterior aspect of leg

& foot

Inability to extend
the leg and flex
hip,
loss
of
cutaneous
sensation
Inability to adduct
the thigh

Inability to plantar
flex & invert the
foot, shuffling gait

Plexus
Sacral

Important
Nerves
Superior &
Inferior
Gluteal

Body Areas Served

Gluteus muscles

Result if
Damaged
Inability to extend
the hip (maximus)
or abduct and
medially rotate the
thigh (medius)

AUTONOMIC NERVOUS SYSTEM

SYMPATHETIC NERVOUS SYSTEM
Called the FIGHT or FLIGHT system
Also called the ADRENERGIC SYSTEM
Four Main Adrenergic receptors:
Alpha
located in vascular tissues (vessels) of smooth
muscles
Stimulated: increases force of heart contraction.
Vasoconstriction increasing BP. Mydriasis
dilates the pupils. Glandular decreases salivary
secretion
Alpha
Inhibits release of norepinephrine dilates blood
vessels
thus
decreasing
BP,
producing
Hypotension

SYMPATHETIC NERVOUS SYSTEM

Four Main Adrenergic receptors:
Beta
located primarily in the heart
Stimulated: increases heart rate and force of
contraction / myocardial contractility
Beta
Mostly in the smooth muscles of the lungs,
arterioles of skeletal muscles and the uterine
muscles
Stimulation: bronchodilation, increased blood flow
to skeletal muscles and uterine relaxation
Other Adrenergic receptors:
Dopaminergic
Located in renal, mesenteric, coronary and
cerebral arteries
Stimulated: vessels dilate & blood flow increases

SYMPATHETIC NERVOUS SYSTEM

Neurotransmitters used:
Epinephrine
Norepinephrine
Dopamine
collectively, these are called Catecholamines
PARASYMPATHETIC NERVOUS SYSTEM
Neurotransmitter used:
Acetylcholine
Two Main Adrenergic receptors:
Muscarinic Receptors
Stimulate smooth muscles and slows down the
heart rate
Nicotinic Receptors
Affects skeletal muscles

EFFECTS OF THE ANS

Organ
Eye (iris)
Eye
(Ciliary muscle)

PSNS
Constricts pupils
Contraction for
vision

SNS
near

Dilates Pupils
Relaxation
for
vision

far

Lacrimal Glands

Production of tears

Inhibits : dry eyes

Salivary Glands
Sweat Glands
Digestive
System

Production of saliva
No effect
Increased
peristalsis
and
amount
of
secretion, relaxation of
sphincters

Decreased : dry mouth

Perspiration
Decreased activity and
amount of secretion,
constriction
of
sphincters

Adrenals
Liver
Lungs
Heart

No effect
No effect
Bronchoconstriction
Dereased HR, slows
and steadies

Hormone secretion
Release of Glucose
Bronchodilation
Increased HR & force
of contraction

Organ
Urinary bladder

PSNS

SNS

Relaxes
sphincters
(allowing voiding)
No effect

Constricts sphincters
(Prevents voiding)
Decreased
urine
production

Blood vessels

No effect on most,
dilation on a few (penis)

Arrector Pili
Muscles

No effect

Constricts in viscera
and skin / dilates
those
in
skeletal
muscles and heart,
increased BP
Hair
erection
goosebumps

Cellular
Metabolism

No effect

Penis

Erection

Uterus

No effect

Kidneys

Increased metabolic
rate, increased blood
sugar and stimulates
fat breakdown
Ejaculation
Contraction
pregnant women

in

ASSESSMENT

Subjective
Data

Glasgow Coma Scale

Technique of objectifying a clients level of
responses;clients best response in each area is given a
numerical value,and the three values is totaled for a score
ranging from 3 - 15.
EYE OPENING ABILITY:
Spontaneous
---------To voice / speech ---------To pain
---------None
----------

(4)
(3)
(2)
(1)

 BEST MOTOR RESPONSE - UPPER LIMB:

Obeys commands
---------Localizes to pain
---------Flexor withdrawal(decorticate posturing) ---------Abnormal flexion(decerebrate posturing) ---------Extension
---------Flaccid
----------

(6)
(5)
(4)
(3)
(2)
(1)

BEST VERBAL RESPONSE:

Oriented
Confused conversation
Inappropriate words
Incomprehensible sounds
None

(5)
(4)
(3)
(2)
(1)

----------------------------------------------

A score of 15 indicates client is awake and oriented.

A score of 7 - 4 is considered coma.
The lowest score is 3,client is considered in deep coma.

Decorticate/Decerebrate

Cranial Nerve Testing

Cranial
Nerve

Procedure

Test the sense of smell

II

Test visual acuity

Test visual fields by confrontation

III, IV, VI

Check pupils for size, regularity, equality, direct and consensual

light reaction and accomodation
Assess extraoccular movements
Assess for nystagmus

Assess the muscles of mastication

Assess the sensory function by touching a cotton wisp to
different areas of the face
Assess corneal reflex

VII

Note mobility and facial symmetry

Test the sense of taste

Cranial Nerve Testing

Cranial
Nerve
VIII

Procedure

Test hearing acuity

Test using tuning forks

IX and X Let the pt say ahh and note pharyngeal movement

Test sense of taste on the posterior 1/3 of the tongue
XI

Examine the sternomastoid and trapezius muscles for

equal size

XII

Inspect tongue

Cranial Nerve 1
Evaluate the patency
Let patient close eyes and occlude one nostril
Put something under the nose and let the pt identify

Cranial Nerve II
Use visual acuity chart
Hold chart 14 inches from the face
Cover one of their eyes completely with hand

Cranial Nerve II
Test fields via confrontation
Examiner should face the patient one foot
away at eye level
Ask pt to cover R eye with R hand and let
pt look at the examiner in the eyes
Enter from out of sight the examiners
finger and cover L eyes with L hand (E)
Extend (E) arm and first 2 fingers out to
the side as far as possible
Bring hand centrally and let the patient
say now when E fingers enters visual
field

Cranial Nerve III

Assess PERRLA

Pupillary Changes to Light

Cranial Nerves III, IV and VI

Cranial Nerve V

Cranial Nerve VII

Cranial Nerve VIII

Cranial Nerve IX
Ask patient to swallow and note any difficulty in doing so
Let the patient say aahhh and observe pts mouth, soft palate, uvula and
pharynx.

Cranial Nerve X

Cranial Nerve XI

Cranial Nerve XII

Test for Cerebral Function

Rapid Alternating Movement
Balance Test

Test for Cerebral Function

Romberg Test

Test for Cerebral Function

Finger to Nose Test

Test for Cerebral Function

Finger to finger test

Test for Cerebral Function

Heel to Shin Test

Assessment of the sensory-motor

system
Kinesthesia

Assessment of the sensory-motor

system

Assessment of the sensory-motor

system
Stereognosis

Assessment of the sensory-motor

system
Graphesthesia

Assessment of the sensory-motor

system
Two point Discrimination

Assessment of the sensory-motor

system
Extinction

Test for Reflexes

Biceps
Triceps
Brachioradialis
Patellar
Achilles
Plantar
Abdominal
Anal
Cremasteric
Bulbocavernosus

Test for Reflexes

Sample Charting

Slide 23-68

Sample Charting
(cont.)

Slide 23-69

Sample Charting
(cont.)

Slide 23-70