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Amyotrophic Lateral Sclerosis (ALS) (Downstream effects (Dementia (Have…
Amyotrophic Lateral Sclerosis (ALS)
Downstream effects
Eating problems
ALS can develop malnutrition and dehydration from damage to the muscles that control swallowing
Can also be treated with medicines
Higher risk of getting food, liquids or saliva into the lungs
Cause pneumonia
Dementia
Have problems with memory and decision-making
Antidepressants that alter brain chemistry in certain ways can improve mood
Eventually diagnosed with a form of dementia called frontotemporal dementia
Is not a common feature associated with ALS
The few available treatments
Edaravone (Radicava) and Riluzole (Rilutek) are the only approved medications
Speaking problems
Starts as occasional, mild slurring of words, but becomes more severe
Speech eventually becomes difficult for others to understand
Often rely on other communication technologies to communicate.
Breathing problems
ALS paralyzes the muscles you use to breathe
Need a device to help you breathe at night, similar to what someone with sleep apnea might wear
Given continuous positive airway pressure (CPAP)
Bilevel positive airway pressure (BiPAP)
Tracheostomy
A surgically created hole at the front of the neck leading to the windpipe (trachea)
For full-time use of a respirator that inflates and deflates their lungs.
Respiratory failure
Most common cause of death for people with ALS
Difficulty walking or doing normal daily activities
Physical therapy
Learn to adjust to their physical disabilities
Can maximize existing capabilities
Prevent further loss of motion or prevent pain that may develop from stiff joint
Background information
Physiology
Neurons / Neuron structure
Neuron structure
Sensory neuron
Transmits the sensory impulses to the Central Nervous System (CNS)
Interneuron
Processes / integrates sensory impulses then predicts the correct motor response
Motor neuron
Transmits the motor impulses from the CNS to effector
Neurons
Send and receive signals from your brain
The cells that make up brain and nervous system
Allow us to move our muscle, fell the external world, think, form memories and much more
Ascending & descending tracts
Responsible for carrying sensory and motor stimuli to and from the periphery (respectively).
Descending tracts
Motor neurons in the brain (or brainstem) give the directions
Skeletal muscle respond to these directions
Ascending tracts
Receptors through the body collect information
That information is sent to the brain for processing
Spinal cord
A long, thin bundles of nervous tissue
Support cells connected to the brain
Located along your back and neck
Receives and transmits electric signals throughout the entire body and then back to the brain
Specific examples
Descending tracts
The corticospinal tract
Initiation/control of the precision/speed of skilled, voluntary movements
The vestibulospinal tract
Maintenance of upright posture and balance
Responds to vestibular stimulation and cerebellar control
Ascending tracts
The spinocerebellar tract
Carries information from the muscle spindles, Golgi tendon organs and pressure receptors
The spinothalamic tract
Carry pain, temperature, non discriminative touch and pressure information to the thalamus
Cerebrum
The largest and uppermost portion of the brain
Composed of right and left hemispheres
External structure
Postcentral gyrus
Involved in many of the body's sensory functions
Precentral gyrus
Regulates many of the body's motor functioms
Each hemisphere controls the opposite side of the body
Left hemisphere
Controls speech, comprehension, arithmetic, and writing
Right hemisphere
Controls creativity, spatial ability, artistic, and musical skills
Each hemisphere has 5 lobes
Occipital lobe
Visual information
Frontal lobe
Personality
Motor functions
Temporal lobe
Hearing
Smell
Insula
Taste
Parietal lobe
General sensory functions
Internal structure
White matter
Allows faster signal transport and directly affects the normal sensory and motor functions
Gray matter
A key role in controlling sensory and muscular activity
The process of movement
Basal nuclei
Strongly interconnected with the cerebral cortex, thalamus, and brainstem, as well as several other brain areas
Prevent unwanted movements
Help to regulate muscle movement
Cerebellum
Motor learing
Balance and equilibrium
Fine movement coordination
Sense of body position
The role of the precentral gyrus
Responsible for controlling voluntary motor movement on the body's contralateral side
Descending spinal cord tracts
The pathways by which motor signals are sent from the brain to lower motor neuron.
Then directly innervate muscles to produce movement
Anatomy
Neurons / Neuron structures
Neuron structure
Motor neuron
Ventral gray horn
Ventral root
Lateral gray horn
Interneuron
Dorsal gray horn
Sensory neurons
Dorsal root
Dorsal root ganglion
Neurons
Also known as nerve cells
Myelined sheath
Cell body
Nodes of Ranvier
Nissil body
Axon terminal
Dendrites
Axon hillock
Schwann cell
Axon
Ascending & descending tracts
Founds in white matter
Which travel up and down the cord
Descending tracts
Motor tracts
Have two neurons
Lower motor neuron
Upper motor neuron
Ascending tracts
Sensory tract
Have 3 neurons
The 2nd order neuron
The 3rd order neuron
The 1st order neuron
Spinal cord
Begins at the brainstem and ends at about the second lumbar vertebra
Meninges
Covered in protective tissue
Dura matter
The thickest membrane around the brain
Arachnoid mater
The underneath dura matter
Pia mater
The deepest
Cross section
Made of gray and white matter just like other parts of the CNS
Gray matter
Butterfly-shaped central part of the spinal cord
White matter
Surrounds the gray matter and is made of axons
Protected by the vertebrae
Which are bones running down your back
The spinal cord is divided into cervical, thoracic, and lumbar regions
Specific examples
Descending tracts
The corticospinal tract
Basic facts
Descending supraspinal motor tract
The vestibulospinal tract
Basic facts
Supraspinal and Subcortical
Indirect route to LMNs
Allows the cerebellum to influence LMNs
Ascending tracts
The spinothalamic tracts
Found in the spinal cord and thalamus
2nd order neuron
Dorsal gray horn
3rd order neuron
Thalamus
1st order neuron
Dorsal gray horn
The spinocerebellar tracts
Found in the spinal cord and cerebellum
2nd order neuron
Send their fibers up the spinocerebellar tracts and end in the cerebellum
No 3rd order neuron
1st order neuron
Muscles and tendons
The process of mevement
The role of the precentral gyrus
The anatomical location of the primary motor cortex
The primary motor cortex is topographically organized and creates a somatotropic map
Basal nuclei
Made of gray matter
A group of structures found deep within the cerebral hemispheres
Cerebellum
Receives information from the sensory systems, the spinal cord, and other parts of the brain
Then regulates motor movements
Descending spinal cord tracts
Creating and transmitting the output
Responsible for initiating both voluntary and involuntary motion
Cerebrum
Main structure of the brain
Extends from the frontal bone anterior to the occipital bone posterior
Internal structure
Comprised of two different types of tissue
White matter
Forms the bulk of the deeper parts of the brain
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Gray matter
Forms the surface of ech cerebral hemisphere
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External structure
The cerebrum has a highly convoluted appearance
Consisting of sulci and gyri
Gyri
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Sulci
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The longitudinal fissure divides the cerebrum into two cerebral hemispheres
Each cerebral hemisphere divided into 5 lobed
Occipital lobe
The most posterior part of the cerebrum situated below the occipital bone
Temporal lobe
Sits beneath the temporal bone
Inferior to the frontal and parietal lobes
Parietal lobe
Found below the parietal bone
Between the frontal lobe anteriorly and the occipital lobe posteriorly
Insula
This area of the cerebrum is deep to the temporal bone
Frontal lobe
Located beneath the frontal bone
The most anterior region of the cerebrum
Upstream causes
Direct causes
A progressive nervous system disease
That affects nerve cells in the brain and spinal cord
Causing loss of muscle control.
The motor neurons to gradually deteriorate, and then die
When motor neurons are damaged, they stop sending messages to the muscles, so the muscles can't function.
Indirect causes
Since her 20's, she has been an avid pool player
Even competing in her local amateur pool league
Some lifestyle factor
Heredity
Her brother died from ALS when he was 31
She suspects that her dad died from ALS as well
Age
She is 52 year old
Military service
She is a pround Gulf War veteran