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Spinal Cord (reflexes (reflex chain (at least 2 neurons (interneurons),…

- - - - hypetonia
      - plegia
      - ataxia
      - paresis
      - atonia
      - hyporeflexia
      - areflexia
      - hyperreflexia
      - spasticity
    - - multisynaptic
        
        withdrawl reflex
        
        brachioplexus C6-T2
        
        lumbosacral plexus L4-S3
        
        nociceptors
        
        interneurons
        
        contract flexors
        
        inhibit extensors
        
        panniculus reflex
        
        intersegmental transmission
        
        cutaneous truncii
        
        spinothalamic
        
        nociceptor
      - monosynaptic
        
        myotactic
        
        hypertonia
        
        UMN damage
        
        hypotonia
        
        LMN damage
        
        muscle tone
        
        muscle spindle
        
        wraps around an intrafusal muscle fiber
        
        reflex areas
        
        patellar
        
        femoral n.
        
        biceps reflex
        
        C6-C8
        
        triceps reflex
        
        C7-T1
        
        perineal
        
        pudendal n.
        
        muscle length-tension relationship resposne
  - - - interneurons
- - - - thermal
      - pain
      - itch
      - nociceptors
    - - light touch
      - hair follicle
    - - pressure
      - muscle spindles
      - Pacinian corpuscle
        
        skin
  - - - vibrissae
      - skin
      - subq
      - mechanoeceptors
    - - connective tissue
      - skin
      - muscle spindle
      - joints
      - tendons
    - - viscera
      - baroreceptor
  - - - polymodal
      - TRP channels
      - extreme stimuli
- - - - phasic/ rapid adaption
      - tonic/slow adaption
- - - - dorsal
        
        somatic and visceral sensory axons
        
        tactile
        
        thermal
        
        noxious
      - lateral
        
        preganglionic sympathetic cell bodies
      - ventral
        
        somatic motor neuron cell bodies
  - - - dorsal
        
        ascending afferent axons
        
        dorsal columnar path
        
        2nd order crossing at medulla of the brainstem
        
        contralateral into the thalamus
        
        CNS input
        
        proprioceptive
        
        damage: ataxia
      - lateral
        
        ascending afferent
        
        spinothalamic tract
        
        noxious
        
        thermal
        
        decussate at midline immediately
        
        descending efferent
        
        upper motor neurons
        
        damage: communication issues from UMNs to LMNs
        
        corticospinal tract
      - ventral
        
        descending efferent
        
        UMNs to axial mm.
        
        damage: posture affected
  - - - cervical enlargement
      - thoracic limbs
    - - lumbosacral enlargement
      - pelvic limbs
    - - canus medullaris
- - - - sensitization
        
        central chronic
        
        doesn't require noxious input
        
        hyperalgesia
        
        allodynia
        
        spontaneous activity
        
        increased glutamate release
        
        increase dorsal horn excitability
        
        alterations in interpretation of sensory input
        
        increase CNS responsiveness
        
        upregulate channel proteins
        
        substance P
        
        nerve growth factor (NGF)
        
        brain-derived neutropic factor (BDNF)
        
        increase efficiency in synaptic transfer
        
        how it occurs
        
        alterations in gene expresson
        
        activate neuroglia
        
        release inflammatories
        
        IL-1
        
        block endogenous pathways
        
        peripheral chronic
        
        gene expression alteration
        
        downregulation
        
        opioid receptors
        
        K channels
        
        upregulation
        
        SNS
        
        TRP
        
        inlammatory mediators at DRG
        
        basis: increasing Na and CA in cells
      - neuropathy
      - pathologic
    - - acute peripheral sensitization
        
        prevents further injury
        
        tissue damage
        
        release of sensitizing agents
        
        serotonin 5-HT
        
        nerve growth factor (NGF)
        
        prostaglandins
        
        phosphorylation of nociceptive ion channels
        
        TRP
        
        sensory neuron specific Na (SNS)
        
        reduced threshold
        
        hyperalgesia
  - - - attention to painful area
      - demeanor
      - response to
        
        people
        
        food
        
        touch
      - vocalization
      - posture
      - mobility
      - activity level
      - physiological signs
    - - orbital tightening
      - muscle tension around eye
      - strained nostrils
      - backwards, tense ears
      - tense stare
    - - inhibit
        
        perception
        
        transduction
        
        transmission
      - spinal pathway modulation
      - types
        
        local anesthetic
        
        dorsal root ganglion
        
        primary afferent nerve
        
        ex. lidocaine
        
        nerve block
        
        nerve endings
        
        corticosteroids
        
        reduce inflammation
        
        increase thirst, appetite
        
        ex. prednisone, cortisol
        
        NSAIDs
        
        nerve endings
        
        reduce inflammation
        
        long-acting
        
        may affect
        
        liver
        
        kidneys
        
        clotting
        
        stomach
        
        ex. carprofen
        
        alpha-2 agonists
        
        dorsal root ganglion
        
        anesthesia
        
        large animal sedative
        
        inhibitory fibers
        
        ex. xylazine, medetomidine
        
        opioids
        
        inhibitory fibers
        
        dorsal horn
        
        sedation
        
        mood changes
        
        ex. morpine, fentanyl
    - - enkephalin
      - dynophins
      - endorphins
      - periaquaductal grey matter (PAG)
        
        increases density of opioid receptors
        
        surround brain ventricles
        
        stimulation
        
        activation of descending neruons
        
        inhibitory interneurons release endogenous opioids
        
        activation of opioid receptors
        
        inhibit substance P
        
        inhibit 2nd order spinothalamic