Chapter12 (1).pptx

Chapter 12 Altered Somatic and Special Sensory Function Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Somatosensory System #1 Sensations o Pain (nociception) o Touch o Temperature o Body position (proprioception) Copyright © 2023 Wolters Kluwer · All Rights Reserved Neurons...

Chapter 12 Altered Somatic and Special Sensory Function Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Somatosensory System #1 Sensations o Pain (nociception) o Touch o Temperature o Body position (proprioception) Copyright © 2023 Wolters Kluwer · All Rights Reserved Neurons of the Somatosensory System Copyright © 2023 Wolters Kluwer · All Rights Reserved Somatosensory System #2 Relay sensory information from the periphery to the CNS o Sensory receptors o Ascending pathways o Processing centers Copyright © 2023 Wolters Kluwer · All Rights Reserved Somatosensory Receptor Classification Copyright © 2023 Wolters Kluwer · All Rights Reserved Somatosensory Neuronal Organization First-order neuron Second-order neuron Third-order neuron Copyright © 2023 Wolters Kluwer · All Rights Reserved Somatosensory Neuronal Transmission Dorsal root ganglia fibers Dermatome innervation Pathways o Discriminative pathway o Anterolateral pathway Copyright © 2023 Wolters Kluwer · All Rights Reserved Somatosensory Processing Awareness, recognition, identification, and interpretation of stimuli o Primary processing in the thalamus o Processing refined in the somatosensory cortex o Interpretation in the somatosensory association areas Copyright © 2023 Wolters Kluwer · All Rights Reserved Somatosensory Modalities Acuity Tactile  Touch  Pressure  Vibration Thermal Position Copyright © 2023 Wolters Kluwer · All Rights Reserved Pain Nociceptive o Stimulus originates outside nervous system Neurogenic or neuropathic o Stimulus originates within nervous system Copyright © 2023 Wolters Kluwer · All Rights Reserved Conduction of Pain Sensation #1 Stimulation of free nerve endings o Chemical, mechanical, or thermal stimuli Transduction of noxious stimuli into a nerve impulse Transmission from tissues to CNS o Type A (delta) and C fibers o Induction of autonomic and reflex responses Copyright © 2023 Wolters Kluwer · All Rights Reserved Mechanism of Acute Pain Copyright © 2023 Wolters Kluwer · All Rights Reserved Conduction of Pain Sensation #2 Modulation o Substances released during impulse transmission o Slow the rate of impulse transmission Perception o Sensory (somatosensory cortex) and emotional (limbic system) involvement Copyright © 2023 Wolters Kluwer · All Rights Reserved Theories of Pain Pattern theory Specificity theory Gate control theory Intensity theory Neuromatrix theory Copyright © 2023 Wolters Kluwer · All Rights Reserved Tool for Characterization of Pain Copyright © 2023 Wolters Kluwer · All Rights Reserved Classifications of Pain Location  Diffuse  Cutaneous  Throbbing  Deep  Stabbing  Visceral  Referred Quality  Sharp  Burning Duration  Acute  Chronic Copyright © 2023 Wolters Kluwer · All Rights Reserved Treatment of Pain Nonpharmacologic  Transcutaneous electrical nerve stimulation  Acupuncture Cognitive–behavioral  Relaxation  Distraction  Cognitive reappraisal Pharmacologic  Nonnarcotic analgesics  Biofeedback  Opioid analgesics Physical agents  Adjuvant analgesics  Imagery    Heat and cold Copyright © 2023 Wolters Kluwer · All Rights Reserved Vision #1 Involves integration of eye structures, motor control, and neural control  Cornea  Pupil  Iris  Lens  Ciliary muscles  Chambers  Retina Copyright © 2023 Wolters Kluwer · All Rights Reserved Vision #2 Photoreceptors  Located in retina  Rods  Vision in dim light  Cones  Visual acuity  Bright light  Color Copyright © 2023 Wolters Kluwer · All Rights Reserved Vision #3  Trochlear (IV) Extraocular muscles   Abducens (VI) Eye movements   Rotation Movement types  Horizontal movement  Saccades  Vertical movement  Pursuit  Six paired muscles  Convergence/ divergence  Cranial nerves  Vestibular  Oculomotor (III)  Fixation maintenance Copyright © 2023 Wolters Kluwer · All Rights Reserved Extraocular Eye Muscles Copyright © 2023 Wolters Kluwer · All Rights Reserved Vision #4 Protective eye structures  Eyelids/eyelashes  Lacrimal glands  Tear production  Ciliary body  Aqueous humor production  Trabecular network  Aqueous humor reabsorption Copyright © 2023 Wolters Kluwer · All Rights Reserved Vision #5 Errors in refraction o Myopia o Hyperopia o Astigmatism o Presbyopia Copyright © 2023 Wolters Kluwer · All Rights Reserved Errors in Refraction Copyright © 2023 Wolters Kluwer · All Rights Reserved Vision #6 Alterations in eye movement o Strabismus o Amblyopia o Diplopia o Nystagmus Copyright © 2023 Wolters Kluwer · All Rights Reserved Vision #7  Alterations in protective structures  Conjunctivitis Viral Bacterial Allergic  Cataracts Nuclear Cortical Posterior subscapular Copyright © 2023 Wolters Kluwer · All Rights Reserved Vision #8 Treatment of alterations Manifestations and in vision evaluation of alterations in vision  Glasses  Vision screening (acuity)  Contacts  Near distance  Patching  Far distance  Surgery  LASIK  Cataract removal  Glaucoma treatment Copyright © 2023 Wolters Kluwer · All Rights Reserved Hearing #1 Involves integration of neural impulses and function of ear structures Copyright © 2023 Wolters Kluwer · All Rights Reserved Hearing #2 Middle ear Outer ear  Pinna  Tympanic membrane  External auditory/acoustic meatus  Ossicles  Malleus  Incus  Stapes  Mastoid  Eustachian tube Copyright © 2023 Wolters Kluwer · All Rights Reserved Hearing #3  Inner ear    Utricle Oval window  Saccule Cochlea  Organ of Corti  Vestibule Semicircular canals  Fluid  Perilymph  Endolymph Copyright © 2023 Wolters Kluwer · All Rights Reserved Hearing Processes #1 Mechanical energy o Ossicles stimulation of cochlea Hair cell stimulation o Neural signal transmitted to brain via acoustic cranial nerve (VIII) o Midbrain relay center o Dual pathways to right and left auditory cortex Copyright © 2023 Wolters Kluwer · All Rights Reserved Hearing Processes #2 Copyright © 2023 Wolters Kluwer · All Rights Reserved Balance Processes #1 Vestibular function Motion from body movement o Detected by hair cells in the semicircular canals, utricle, and saccule o Organ of Corti Copyright © 2023 Wolters Kluwer · All Rights Reserved Balance Processes #2 Hair cell stimulation o Neural signal transmitted to the cerebellum via the vestibular branch of the acoustic cranial nerve Integrated in the vestibular nuclei o Visual, somatic input o Modulates eye and reflex movements Copyright © 2023 Wolters Kluwer · All Rights Reserved Alterations in Hearing and Balance #1 External ear o Obstruction  Cerumen  Mass o Inflammation  Otitis externa Copyright © 2023 Wolters Kluwer · All Rights Reserved Alterations in Hearing and Balance #2 Middle ear o Barotrauma o Inflammation  Otitis media  Mastoiditis o Otosclerosis o Conductive hearing loss Copyright © 2023 Wolters Kluwer · All Rights Reserved Alterations in Hearing and Balance #3 Inner ear o Neural dysfunction  Tinnitus  Sensorineural hearing loss (presbycusis) o Equilibrium disruption  Ménière disease o Inflammation  Labyrinthitis Copyright © 2023 Wolters Kluwer · All Rights Reserved Hearing Screening Acuity (decibels) Frequency or pitch (hertz) Classification of hearing loss o Conductive o Sensorineural o Mixed o Central auditory processing disorder Copyright © 2023 Wolters Kluwer · All Rights Reserved Evaluation of the Middle and Inner Ear Middle ear o Tympanometry o Acoustic reflex measurement Inner ear o Pure-tone bone conduction o Vestibular evoked myogenic potential test o Otoacoustic emission Copyright © 2023 Wolters Kluwer · All Rights Reserved Taste Mediated by chemoreceptors o Taste buds Sensation types o Sweet o Sour o Salty o Bitter o Savory Copyright © 2023 Wolters Kluwer · All Rights Reserved Taste Processes #1 Signal initiation o Binding of dissolved substance with taste receptor o Signal transmitted along facial (VII) and glossopharyngeal (IX) cranial nerves Copyright © 2023 Wolters Kluwer · All Rights Reserved Taste Processes #2 Signal processing o Thalamus Signal interpretation o Gustatory cortex in the parietal lobe o Modulated by visual, thermal, scent, and pain Copyright © 2023 Wolters Kluwer · All Rights Reserved Smell Processes Signal initiation o Olfactory receptors in nasal cavities o Transmitted along olfactory (I) cranial nerve Signal processing and interpretation o Via ascending fibers to the olfactory bulb and olfactory cortex Copyright © 2023 Wolters Kluwer · All Rights Reserved Sensory Alternations Copyright © 2023 Wolters Kluwer · All Rights Reserved Application of the Concepts of Altered Somatic and Special Sensory Function Fibromyalgia Macular degeneration Migraine headache Glaucoma Otitis media Retinopathy of prematurity Ménière disease Copyright © 2023 Wolters Kluwer · All Rights Reserved Fibromyalgia Pathophysiology Clinical manifestations Diagnostic criteria Treatment Copyright © 2023 Wolters Kluwer · All Rights Reserved Fibromyalgia Pathophysiology Disorder of the soft tissues and muscles Cause: none known Copyright © 2023 Wolters Kluwer · All Rights Reserved Fibromyalgia Clinical Manifestations Fatigue Pain  Neck  Shoulders  Back  Elbows  Hips Depression may coexist Copyright © 2023 Wolters Kluwer · All Rights Reserved Fibromyalgia Diagnostic Criteria Subjective findings o History of fatigue o Chronic musculoskeletal pain  At least 3 months’ duration  At least 12 of 18 identified tender point sites  Trigger points Copyright © 2023 Wolters Kluwer · All Rights Reserved Fibromyalgia Treatment Nonpharmacologic  Cognitive–behavioral therapy  Alternative treatment Pharmacologic  Analgesics  Stress reduction   Gentle exercise Antidepressants   Application of heat and cold Anticonvulsants  Muscle relaxants  Ultrasound  Deep massage Copyright © 2023 Wolters Kluwer · All Rights Reserved Migraine Headache Pathophysiology Clinical manifestations Diagnostic criteria Treatment Copyright © 2023 Wolters Kluwer · All Rights Reserved Migraine Headache Pathophysiology Recurrent headaches o Moderate-to-severe intensity o Duration of 1-2 days o Associated with nausea, vomiting, and sensitivity to noise and light Cause: likely initiated by neurologic and biochemical events Copyright © 2023 Wolters Kluwer · All Rights Reserved Migraine Headache Clinical Manifestations Pain o Unilateral o Pulsing and throbbing Aura o Visual disturbances preceding headache may be associated Prodromal symptoms o Mood changes, food cravings, constipation Copyright © 2023 Wolters Kluwer · All Rights Reserved Migraine Headache Diagnostic Criteria History Physical examination Imaging for acute, sudden onset o MRI o CT Copyright © 2023 Wolters Kluwer · All Rights Reserved Migraine Headache Treatment #1 Prevention indicated for individuals who: o Have ≥2 migraines each month o Use pain-relieving medications ≥2 times per week o Experience inadequate relief from analgesic treatment o Have uncommon migraines Copyright © 2023 Wolters Kluwer · All Rights Reserved Migraine Headache Treatment #2 Nonpharmacologic prevention strategies o Avoidance of triggers o Regular exercise o Smoking cessation o Hormone level stabilization Copyright © 2023 Wolters Kluwer · All Rights Reserved Migraine Headache Treatment #3 Pharmacologic  Acetaminophen  NSAIDs  Aspirin  Triptans  Antiemetics  Ergots  CGRP receptor antagonists  Anticonvulsants Copyright © 2023 Wolters Kluwer · All Rights Reserved Otitis Media Pathophysiology Clinical manifestations Diagnostic criteria Treatment Copyright © 2023 Wolters Kluwer · All Rights Reserved Otitis Media Pathophysiology #1 Acute otitis media (AOM) o Infection in the middle ear  Effusion (fluid) in middle ear creates an optimal environment for pathogen growth. o Associated with upper respiratory infections Copyright © 2023 Wolters Kluwer · All Rights Reserved Otitis Media Pathophysiology #2 Otitis media with effusion (OME) o Effusion (fluid) in the middle ear  Trapping of fluid by obstruction in the eustachian tube o Not associated with infection or inflammation Copyright © 2023 Wolters Kluwer · All Rights Reserved Classification of Otitis Media Copyright © 2023 Wolters Kluwer · All Rights Reserved Otitis Media Clinical Manifestations #1 General manifestations o Acute ear pain o Enlarged periauricular lymph nodes o Rhinorrhea (runny nose) o Fever o Impaired hearing o Perforated tympanic membrane Copyright © 2023 Wolters Kluwer · All Rights Reserved Otitis Media Clinical Manifestations #2 AOM o Acute onset o Middle ear effusion o Inflammation o Recurrent  ≥3 episodes in 6 months or ≥4 over 1 year OME o Middle ear effusion without inflammation Copyright © 2023 Wolters Kluwer · All Rights Reserved Otitis Media Diagnostic Criteria #1 History of acute onset Otoscopic exam o Effusion  Bulging tympanic membrane Limited or absent mobility Visible air–fluid level  Otorrhea (ear canal discharge) Copyright © 2023 Wolters Kluwer · All Rights Reserved Otitis Media Diagnostic Criteria #2 Otoscopic exam (cont.) o Inflammation  Redness/erythema of tympanic membrane  Pain that interferes with activity/sleep Copyright © 2023 Wolters Kluwer · All Rights Reserved Otitis Media Treatment Based on accurate diagnosis o AOM versus OME Observation o OME and uncomplicated AOM Antibiotics o In AOM unresponsive to observation Copyright © 2023 Wolters Kluwer · All Rights Reserved Ménière Disease Pathophysiology Clinical manifestations Diagnostic criteria Treatment Copyright © 2023 Wolters Kluwer · All Rights Reserved Ménière Disease Pathophysiology Altered vestibular function o Increased volume of endolymph leads to dilation of the membranous labyrinth of the inner ear. o Rupture of membranous labyrinth allows mixing of endolymph and perilymph. Copyright © 2023 Wolters Kluwer · All Rights Reserved Ménière Disease Clinical Manifestations Often unilateral Variable in severity o Vertigo o Nausea and vomiting o Sensorineural hearing loss o Pressure, pain o Tinnitus and nystagmus Copyright © 2023 Wolters Kluwer · All Rights Reserved Ménière Disease Diagnostic Criteria History of symptoms Physical examination o Auditory exam o Auditory brain stem response o Glycerol test o Electrocochleography o Electronystagmography o Caloric test Copyright © 2023 Wolters Kluwer · All Rights Reserved Ménière Disease Treatment #1 Management of symptoms Regulation of body fluid Smoking cessation Stress reduction Copyright © 2023 Wolters Kluwer · All Rights Reserved Ménière Disease Treatment #2 Pharmacologic o Diuretic therapy o Antiemetics Surgical o Ototoxicity o Vestibular neurectomy o Labyrinthectomy Copyright © 2023 Wolters Kluwer · All Rights Reserved Macular Degeneration (MD) Pathophysiology Clinical manifestations Diagnostic criteria Treatment Copyright © 2023 Wolters Kluwer · All Rights Reserved MD Pathophysiology Degeneration of the fovea o Central portion of the retinal macula Categories o Dry (atrophic)  Drusen deposition o Wet (exudative)  Choroidal neovascularization Copyright © 2023 Wolters Kluwer · All Rights Reserved Macular Degeneration Copyright © 2023 Wolters Kluwer · All Rights Reserved MD Clinical Manifestations #1 General o Distortion of central vision o Decreased ability to read, recognize faces, colors o Blindness Copyright © 2023 Wolters Kluwer · All Rights Reserved MD Clinical Manifestations #2 Progression o Dry/atrophic  Slow progression of symptoms o Wet/exudative  Rapid and severe vision loss  Dark central spot Copyright © 2023 Wolters Kluwer · All Rights Reserved MD Diagnostic Criteria Vision screening Ophthalmoscopic exam o Leakage o Bulging macula o Drusen deposition Copyright © 2023 Wolters Kluwer · All Rights Reserved MD Treatment Pharmacologic treatment o Medications that inhibit vessel growth in wet/exudative form o Currently no treatment options for dry form Copyright © 2023 Wolters Kluwer · All Rights Reserved Glaucoma #1 Pathophysiology Clinical manifestations Diagnostic criteria Treatment Copyright © 2023 Wolters Kluwer · All Rights Reserved Glaucoma Pathophysiology #1 Vision loss due to optic nerve damage Categories o Primary open angle  Clogged trabecular network at the point where the iris and cornea meet  Impaired aqueous humor drainage leading to increased intraocular pressure (IOP) Copyright © 2023 Wolters Kluwer · All Rights Reserved Glaucoma Pathophysiology #2 Categories (cont.) o Angle closure  Rapid IOP from blocked aqueous humor drainage o Normal tension  Poor blood flow to optic nerve Copyright © 2023 Wolters Kluwer · All Rights Reserved Glaucoma #2 Copyright © 2023 Wolters Kluwer · All Rights Reserved Glaucoma Clinical Manifestations #1 Primary open angle o Gradual, irreversible vision loss  Blind spots in field of vision  Initially limited to periphery  Progresses centrally Copyright © 2023 Wolters Kluwer · All Rights Reserved Glaucoma Clinical Manifestations #2 Acute angle closure o Induced by increased pupil dilation  Eye pain  Headache  Nausea  Blurred vision  Rainbows around lights at night o Damage to optic nerve leads to vision loss Copyright © 2023 Wolters Kluwer · All Rights Reserved Glaucoma Diagnostic Criteria Vision screening o Visual fields Ophthalmoscopic exam o Optic nerve cupping, pallor, hemorrhage Tonometry o Measure intraocular pressure Copyright © 2023 Wolters Kluwer · All Rights Reserved Glaucoma Treatment Pharmacologic treatment o Medications that increase aqueous humor outflow and fluid levels Surgical treatment o Trabeculoplasty o Trabeculectomy o Iridotomy Copyright © 2023 Wolters Kluwer · All Rights Reserved Retinopathy of Prematurity (ROP) Pathophysiology Clinical manifestations Diagnostic criteria Treatment Copyright © 2023 Wolters Kluwer · All Rights Reserved ROP Pathophysiology Impaired development of retinal blood vessels o Phase 1: Arrested growth o Phase 2: Unregulated growth Hemorrhage and scarring promotes retinal detachment Copyright © 2023 Wolters Kluwer · All Rights Reserved ROP Clinical Manifestations Leukocoria (white pupils) Nystagmus (abnormal eye movements) Strabismus (crossed eyes) Myopia (severe nearsightedness) Copyright © 2023 Wolters Kluwer · All Rights Reserved ROP Diagnostic Criteria #1 Based on morphology of retinal blood vessels Stage 1 o Mildly abnormal blood vessel growth o Spontaneous resolution o Likely develop normal vision Copyright © 2023 Wolters Kluwer · All Rights Reserved ROP Diagnostic Criteria #2 Stage 2 o Moderately abnormal blood vessel growth o Spontaneous resolution o Likely develop normal vision Stage 3 o Severely abnormal blood vessel growth o Some develop normal vision without treatment Copyright © 2023 Wolters Kluwer · All Rights Reserved ROP Diagnostic Criteria #3 Stage 3 Plus o Abnormal growth patterns with enlarged (dilation) or twisted (tortuosity) vessels o Requires early treatment to prevent retinal detachment Stage 4 o Partially detached retina o Requires immediate treatment to save vision Copyright © 2023 Wolters Kluwer · All Rights Reserved ROP Diagnostic Criteria #4 Stage 5 o Completely detached retina o Hemorrhage Copyright © 2023 Wolters Kluwer · All Rights Reserved ROP Treatment Laser treatment Cryotherapy Scleral buckle Vitrectomy Copyright © 2023 Wolters Kluwer · All Rights Reserved