NEUROSCIENCE FOR REHABILITATION

Neuroanatomy for Physical Therapists

Draft Table of Contents

I. Introduction to the Nervous System

A. Neuronal Cytology

B. Neuronal Signaling (excitability, membrane, action potential, AP propagation and fiber diameter, synapses)

C. Functional Organization of the NS

1. PNS (nerve roots, spinal Nn, plexuses, peripheral nerves, sensory endings, motor endplate, Wallerian degeneration, sprouting/regeneration, demyelinating diseases)

2. CNS

a. Support cells

b. Pathways, tracts, fasciculi, funiculi, columns, lemnisci

c. Spinal cord (topology, internal anatomy)

d. Brainstem (topology, internal anatomy)

e. Diencephalon (topology, internal anatomy)

f. Forebrain (topology, internal anatomy)

g. Cerebral cortex topography and functional specialization

3. ANS (sympathetics, parasympathetics, pre- and postganglionics, autonomic ganglia)

II. Blood and CSF Circulation

A. Carotid and Vertebral Aa (circle of Willis)

B. Spinal Cord and Brainstem Blood Supply

C. Forebrain Blood Supply

D. Meninges And Brain Coverings

E. CSF Production And Circulation (hydrocephalus)

III. Development of the CNS

A. Embryonic Brain (dysraphic and myeloschistic defects)

B. Juvenile Brain (CP, MS)

C. Mature Brain (ALS)

D. Aged Brain (Alzheimer’s, dementia, Parkinson’s)

E. Critical Periods and Neuroplasticity

IV. Functional Neuroanatomy by Region

A. Spinal Cord

1. PNS-CNS junction

2. Long ascending somatosensory pathways

a. Dorsal column-medial lemniscus

b. Anterolateral system (Spinothalamic tract)

3. Long descending somatic motor pathways

a. Corticospinal tract

b. UMN-LMN

c. Reflexes

d. Spasticity

4. Brown-Séquard syndrome

B. Brainstem

1. Long pathways

a. DC-ML

b. ALS

c. CST

d. Corticobulbar (Corticonuclear) Tract (unilateral lesion, facial paresis)

2. Medulla

a. CNn nuclei (XII, X, IX, VIII, VII) and peripheral nerves

b. Lateral medullary syndrome

c. Medial medullary syndrome – inferior alternating hemiplegia

3. Pons

a. CNn nuclei (VI, V) and peripheral nerves

b. Locked-in syndrome

c. Middle alternating hemiplegia

d. Acoustic neuroma

4. Midbrain

a. CNn nuclei (IV, III) and peripheral nerves

b. Weber’s syndrome – superior alternating hemiplegia

5. Diencephalon

a. Thalamus

b. Internal capsule

c. Thalamic and capsular lesions

C. Cerebellum

1. Topology, internal anatomy

2. Cerebellar cortex circuitry

3. Afferent input

4. Efferent output

5. Motor learning

6. Balance

7. Ataxia, intention tremor, ipsilateral deficits

D. Forebrain

1. Basal Ganglia (Basal Nuclei)

a. Component nuclei

b. Circuitry

c. Parkinson’s disease

d. Huntington’s chorea

e. Contralateral hemiballismus

2. Cerebrum

a. Cerebral cortex architectonics (6 layers, input and output layers, regional functional differentiation)

b. Fiber systems (superior longitudinal fasciculus, arcuate fasciculus, corpus callosum, anterior commissure, corona radiata, optic radiations)

c. Gyri and sulci

1) Topology

2) Functional differentiation

d. Deficits – TBI, CVA

V. Vestibular System

A. Peripheral Anatomy

B. Brainstem Anatomy

C. Circuitry (local, ascending, and descending pathways, MLF)

D. Vestibulo-ocular Reflexes

E. Lesions (vertigo, nystagmus)

F. Therapeutic Manipulation

VI. Visual System

A. Anatomy (eye through visual cortex) and connectivity

B. Sensory Function

1. Construction of the visual field

2. Deficits (blindness, hemianopsia, quadrantopia, complete blindness, pituitary

tumor, macular degeneration/sparing)

C. Motor Control of the Visual System

1. Eye movements (CN III palsy, CN IV palsy, CN VI lateral rectus and lateral gaze palsies, internuclear ophthalmoplegia)

2. Eye movement reflexes (VOR, oculocephalic reflex, doll’s eye sign)

3. Pupillary reflexes

D. Vestibulo-optic Interactions – functional and therapeutic implications

VII. Reticular Formation

A. Anatomy and Connectivity

B. Neurotransmitters

C. Reticular Activating System

1. Consciousness, arousal, sleep-wake

2. Vital functions

3. Descending pain modulation

4. Lesions (infratentorial herniation, decerebrate/decorticate posturing)

5. Therapeutic manipulation

VIII. Limbic System

A. Anatomy and Connectivity (hippocampal formation, Papez circuit)

B. Learning, Memory, Emotions

C. Olfaction and the Limbic System

C. Lesions (temporal lobe epilepsy, anterograde amnesia, Alzheimer’s, dementia, Korsakoff syndrome, Kluver-Bucy)

IX. Hypothalamus and the ANS

A. Anatomy and Connectivity of the Hypothalamus

B. Central Autonomic Structures

1. Sympathetic (spinal cord lateral horn, preganglionic neurons)

2. Parasympathetic (cranial and sacral preganglionic neurons)

C. Peripheral Autonomics

1. Sympathetic (ganglia, postganglionics)

2. Parasympathetic (ganglia, postganglionics)

D. Lesions (hypothalamic syndrome, complex regional pain syndrome)

X. Pain

A. Peripheral nociceptors – Primary and secondary hyperalgesia

B. Spinal cord dorsal horn (substantia gelatinosa) and spinothalamic tract

C. Reticular formation, PAG, and the hypothalamus – Descending pain modulation

D. Chronic Pain

E. Maladaptive cortical remapping

Appendix 1

Neuroimaging (assessing images and diagnosing lesion)

Appendix 2

The complete neurological exam

Atlas