Neuro Exam 1 Study Guide.pdf

Neuron dendrites evesignalsfromothercells Somacellbody organizes keeps cellfunctional cellmemffers cell holdstogether Axon higherates impulse in theneuron Nodes ofRanvier...

Neuron dendrites evesignalsfromothercells Somacellbody organizes keeps cellfunctional cellmemffers cell holdstogether Axon higherates impulse in theneuron Nodes ofRanvier ftp.adfmifsfmIfeverynode Schwan phduces myelinsheath Nucleus controls theentireneuron A transfers signals toothercells organs myelin ses the speedof signal se from oneneuronto another Axon s w othercells Functioncommunicate w otherneurons neuronstransmitinfo via neurotransmitters sensory motorinfo presynaptic postsynaptic Neurotraffa Fgfromthe presynapticterminals intosynapticcleft across thepostsynapticmembrane through axon to activate thereleaseof neurotransmitters into thesynaptic s fftes.si Tapi transition Me reasesspeedof impulse transmissionnerve conduction ofimpulsefromonenervetonext demyelination ms Whatslows down neuronal communication anoxia lackof oxygen 045sec to causedamage Toxins venomplantpoisonfood neurotoxin spasms8994 8 9198,9 Tardive off condition Spasms lipsmackingphysicalmuscularspasm Synaptic  canoccur overtime occursw addictivesubstancewhichfloodthenervoussystemw dopamine reducingnatural production of dopamine somethingflooding system w neurotransmitters depleted of neurotransmitters at terminalend imbalance of typicalflow receptors canchangeovertime amountorpacechanges Neurodff.fmffse toinfectionsdiseases injuries Beneficial faffsinterventionby microglia cleanup removalof debris alsocauses alotofinflammation canblockhealingof neurons butcanclearup after a fewdays week HarmfulEffects deathof neurons inhibition ofneuralregeneration correlation in stroke alzheimer's disease Parkinson'sdisease MS Slowsprocess of neuroplasticity Neurotrange signals basisofneuronal communication Chemicalsthatrelaymessagesbetween neurons ultimately mediatinghuman behavior rapidinfo processedfromsensoryfeedback motoroutput PNSonly uses Acetylcholine Norepinephrine these neurotransmitters are responsible for alertnessarousal muscular Eff's balancecontrol of Ach B Norep createmuscular CNS uses multiple neurotransmitters acetylcholine regulatesANSautonomicNs involuntaryfunctionsofbody Sympathetic fightorflight parasympathetic rest digest a hhti something eyesopen visuallytrackingengaging Glutamate figurine promotes newlearning Enson's Schizophrenia newconnections GABA excitatory promotesnewlearning in excess fan ad toepilepsy or anxiety Pam releasedduringpleasurablemeaningful occupations activitiesrewardmotivation motor control disorderincludes substance abuse Dimbalance or artificial Ifegulates sleepwavecycles emotionalregulation painregulation depression OCD Imbalances Neuromuscular Function aninterplaybetweensensory motorsystemstocreatesmooth precisemovement Direction matters afferentneurons carrysensoryinformationfromtheouterbody PNS toward the CNS pus sensory CNS Efferent 1 8 motorcommandsfrom cnsto smooth striatedmusclesthatinterfacewithin thePNS motorfromCNS PNS Weneedthe sensorysystem tohave motorcontrol Motor Output primarymotorarea wheremotoroutputoccurs backmost stripoffrontallobe right controls left left controlsright voluntaryconsciousmovement beginning of corticospinaltracts runfrom cortexdownspinalcolumn site ofmotor homunculus Motor Neurons anotherway tothinkaboutmotorneuronsalongsideCNS PNS UppermotorNeurons central nervoussystemhousesthese carriesinformationfrombrain spinalcord to interact w LMN LowerMotorNeurons peripheral nervoussystem houses this carriesinformation to regulateactivityof musclesincludingskeletalmusclesmuscles of head neck theANS SensoryInput Proprioception proprio body's abilityto senseitsposition in space Effiespindlesgolgitendonorgansjointreceptors Receptorsinthissystem protect muscles jointsfromstrain elastic plasticdeformation to controlmusclemovement muscle fugbility MS are proprioceptors sensoryreceptors locatedin skeletalmusclebelly relay a constantflowofinfo aboutlength tensiononthemuscle sensoryfeedbackconstant detectwhen a musclehasbeen stretchedmaximally initiate areflexthatresists the stretch triggersresponse of reflexare goesjusttolevel ofspinalcord If GolgiTendonOrgans GTO mechanism GTOs areproprioceptors sensoryreceptors locatedin tendons ofskeletalmuscle detectwhen amusclehasbeenoverstretched triggerprotectiveresponse formuscletorelax Reduce 4411 1 stuckactivateGTO muscle givestretchto reducehypertoncity alsogivefeedback JointReceptors If Iie of ajointcapsule respondto mechanicaldeformationoccurring inthe jointcapsule  sendinproprioceptiveinfo to theCNS or stretch winjoint Neuromuscular Control If MuscleTone muscle Immuscle tension atrestunconscious MBHfied Ashworthscale motorcontrol howmuchtonicityin muscle musclestrength abilityformuscletocontract createforcevolitional voluntary stay resist manualmuscletest musclestrengthcomesfrom using gettinglarger notreplicating increasingthesize ofthosecells resistancetraining processoftearing rebuildingw sarcomeres nutrition resistancetraining use repetitive Whatsystemsregulatetone central peripheralnervoussystems typically muscle tonepresentationsvaryacrosspopulation Hypotonidge EFF If creasein muscletone UMN nuperenexa hypotoncity Injury flexia spinalcordinjury hypore 2mn belowlevelofinjury hypotonicity lesionto cerebellum playslargeroleintonemanagement LowermotorNeuroninjury brachialplexusinjury laxity in muscle iffesistance to active passive movement causebyCNSdamage cord Formsof hypertonicity Spasticity difficultyw from PROM velocitydependent overingfiring Associatedconditions Spinalcordinjury braininjury cerebral palsy Rigidity difficulty w smoothmotor movement is seerigions  range quality of movement tension osculatingreflex Shouldn't hurt whenranging clonus uncontrolledoscillation beatsofclonus of a muscle thatoccursin spasticmuscle group causedbylesions in CNS pulsatingrespone variouspositionsmayfeelmore at rest what is the neurologicalbasis8ft ne b malities damage to primarymotorarea Frontal lobes damageto brainstemregions hyperactive reflexarcs in PNS propioceptors HowOT can5T Hypertonicity faffedTFetchon agonist goin oppositedirection of movement you want to stretch low109 8 199fasting I Hyeds En onjoint to trigger agonist eurotransmitterstromentaddfgonistogetmonennedy Acetylcholine'The discovered primarilycontrolsmuscleaction I Ftholinergic systemsensoryprocessing attentionsleep arousal inhibitory 9 at themotorendoftheneuromuscular junction resultsin dyskinesiaimpairedmovement LOWlevel resultsinparalysis connected to Akheimers myasthenia enzymethat his stiffinflationfinish in ofonresfefhase.is gravis putin eyeduringcataractrepair medicationsthattargets antihistamines somementalhealthconditionsmedicationincreaseAch caninducewinesia Gamma AminobutyricAcid GABA inhibitorytransmitterof thebrain major it is themassivebrake on excitatoryneurotransmitters thatcancauseanxiety Withoutit neuronsfireuncontrollably clinicalpictureofepilepsy GABA causes anxietydisorders a GABA Ifengage  blocking GABAB masim provememory learning Foods spinachbroccoli mushrooms 8to20minofexercise canincreaselevels Bentos drug veryaddictive Fast to moveawaybecauselongtermeffects Glutamate GLU 9kan III to If inbrain transmitters connected learning memory someresearchhasconnectedglutamateto a treatment foralzheimer's disease Disordered GlutamateConditions Huntington's Ischemia Autism Infatuinson's schizophrenia ures widely hithoods umamiflavor Mse recycles To trouble concentrating mentalexhaustion 88T killsoffbraincellsafter TBI which cankillyou Dopamine feegoodhormone motorsystemcognition thistransmitter motivationreward on dopamingeric tracts inthebrain theycarrythisfromwhereit is produced in thebraintotheplacesthat needit most dopamineaffectsbasalgangliawhichinfluencesmovement paruinsons Toomuch psychosisdisorganizedthinking schizophrenia drugsalsocanincreasedopaminelevels cocaineamphetamines manydrugsusedtotreatpsychosisBlock dopaminecanresult in tardive dyskinesia eatingchocolate drinkingincreaseslevels methincreases1000 isinvolvedinregulationofsleepemotionalcontrol equanimitypainregulation emesis bingingbehaviors pinealglandusesserotonin toproducemelatoninnotas neurotransmitter gegatf.gg wavedepressionsuicidalbehaviorincreasedappetitecarbohydrate cravingsangerOCD disruption in sleep SSRI'sare a class of drugsthatblocksthereuptake of serotonin which levels of serotoninintheb helps common_ Is c exercisesunlight good bloodclotting  g Norepinepff orflight role major inwakefulness arousal helpsapersonattend tostimulus intheir environment Importantagent in pharmaceutical intervention forADHD RitalinCencerta Adderall areprescribedtoincreaseBOTH norepinephrine dopamine My mfg stresshormonein fightflight causesincreasedHR releasesenergyfrom fatstorageincreasesmuscle preparedness betablockers canprevent norepinephrine frombinding to receptors Connection toDepression SNRI's increasesserotonin norepinephrine inbrain duringexercisesleephighproteindiet constrictsbloodvessels steering sensorimotorff.tn Division of Nervoussystem mtmyy 84s II II some parasympathetic ns brain sympathetic ns CNS 7Brain Spinalcord PNS cranialnervessomaticnervoussystem AutonomicNervoussystem innervation arousalHRBP of skeletalmuscles ta SpinalNerves majornervesofthebody transmitmessages betweenspinalcord restofbody 31 Pairs eachhassensory motorbranch right leftset 8 cervical C108 12Thoracic TI TR 5lumbar L1 15 5 Sacral 51 55 1 2 Coccygeal Thespinalnervesrecievesensory messagesfromnerveslocatedin areassuchas skininternalorgans bones Bsend sensorymessagestothesensoryrootsthento sensoryfibers inposteriorpartofspinalco Themotorroots recievemotormessagesfromtheanteriorpart ofthespinalcord send thenervemessagesto thespinalnerves eventually to smallnervebranchesthat activatemuscles in thearms legs otherareasofthebody eachnerveis dedicated to a specific region of thebody efferent miffiting afferent sensory Motor o ofspinalnervecontrol throughoutthebody thatinnervates muscles  each movement requiresone ormore muscle which is activated by a branchof a spinalnerve physie bicepsis controlled by 0516 nY Asiascale is swag Ford injury is diagnosed Spinallevel Action SpinalLevel Action Spinallevel Action knee C1 C2 Neck Flexionextension C506 Forearmsupination 23 14 extension Forearm C3 Necu lateralflexion CT 08 pronation 24 15 Gorsiflexion shoulder wristfleighsion CH elevation CGCT 24 Ls Hipextension 05 8 tination a fingerextension 25 S1S2 Ankle flexion plantar 881948 notation Fingerflexion 1223,24 Ima9fffn 06CT08 c8 ction 1425,5152 05 CG elbowflexion T1 CT CS elbowextension L2 13 HipFlexion C3CHCS innervatiaphragm Clinical connection 5253,54 1788 dEff fi Spinalnervedamaged at theperiphery uninorLMNinjury Lowermotorneuron nerveorpathwaydamaged in the cortexwould thisbeUMN orLMNinjury upper motorneuron Sensory Dermatomes map to demonstratewhatspinalnerveinnervates thatpartofthebody spinalnervesrecievemessagesincludingtouchtemperaturepositionvibration painfromthesmallnervesin thesuin musclesjoints internalorgansofbody eachspinalnervecorresponds to a sunregionof thebodydescribed as dermatome sensorydermatomesdonotmatch perfect w myotomes TCO isbellybutton up CGCT28 ishand Typesof sensory Receptors Specializedcellfor a specializedpurpose exteroceptffside world 5 senses olfactory gustatory interoce sensations Proprioceptffection ofbodyposition movement vestibular coordination Classificationof Sensory Receptors anatomicallocation L Fendon Joint proprioceptors BySen factoryesmen auditory hearing gustatory taste  balance Bystuff mn mechanoreceptors suredistance forcetension Thermo receptors ITEature Chemoreceptors recieved sheet Yed photore É th ripheralNenousystemInjunes Neuropathy nerves pathologyinvolving injuryinvolvingnerves sensorymotorcomponents ANS mechanismfiain immune immune systemattacks diabetes p feed changesaroundnerves Chemotherapy Smoking limitbloodflowaroundnerves Vasculardisease Typesof Neuropathy mononey If polyneuropathy i limb affectsmore than I limb Plexopathyrigan begins at nerveplexus Radiculopathy nerverootinjury affectingdorsalor anteriorhorns Nerveinjuries classification of peripheral Nerveinjuries partialtear completeseverance compress ammation restriction onnervesmovement Pinchnerve bony compression Sensation changes Hypoes the crease in sensoryperception HYPeresffffggj.ge sensory perception  I Paresthesioaccurence ofunusalfeelingssuchas pins needlestingling burning Thermesthesia abilityto percievetemperature hot cold canalsoreferto aheightenedsensivitytoheat wanttomakesure intact Thermo hyperesthesia increase intemperatureperception verysensitive Thermohypoesthia decrease in temperatureperception couldbeat riskforburns orfrostbite Sensorydeficits dyses the leasant sensation suchas burning Causalgia anintenseburningpainaccompaniedby trophic funsalongthedistribution of a nerve Analgesia gs of painsensation P decrease in theability to perceivepain Hyper increase in theability to percieve pain midacondition in which an otherwise innocuous stimuluscauses pain Synaptic Changes AfterInjury Regeneration Collateralsprouting When I neurongrows an additional axon 1102 EE Regenerative sprouting 2 presynaptic neurons communicating to 1 postsynaptic neuron 2 to 1 Motor Pathologies paralysisplegia lossof voluntarymotor control monoplegia paffectsonly 1 armorleg Hemiplegia paffectsone I arm 1 legon thesamesideofthebody paraplegia affectsbothofyourlegs Quadraplegia Daffectsboth ofyourarms legs paresis partial loss of voluntarymotorcontrol Brachi c ftp Ii rounaaxinamartem Brachial painsensory ormotorsymptomsin UE upper I IEEE Is pmuscle sensory downtohand  cg T1 nerveroots motor radial ulnarinnervatedmusclesincluding digit abductorsextensors sensory pinnysidemedialaspect ofdigits Forearm RadialNerveInjury Wrist FingerDrop towrist digitextensors Lateralep dffishervation inflammation offorearmmuscles forwristextension Saturdaynight palsy or radial mononeuropathy compression of axillaryregion fallasleeponarm weaknessin wholearm MedianNervein CarpalTunnelSyndrome pain numbness parathesia ofdigits 1 3 radial of4 overuse tendonitis UlnarNerveInjury Clawhanddeformity compressioninjury digit 4 5MCPextension PIPDIPflexion paralysisoflumbricals CubitalTunnelsyndrome medialelbowcompression pain parathesiadigits4315 Guyon CanalSyndrome compression atwrist pain weakness paresthia ofdigits 4 5 moremedialaspectof flexorretinaculum Sensorymapping of Hand pain dorsal EMIathfacious donadaammagata offffan noradial Lumbo sacralPlexus infegates lowerextremities sciatic 18 uneeextensors burning or shootingpain piriformisis innervatedbythis hard to standupout of chair getin out ofshower Peroneal Nerve Injury Footdrop loss of dorsiflexors in ankle goingupstairs motorontonfTÉtiththitiffffffaranry howwecontrolbodyjointmovement coordination ofCNS PNScombined w muscle jointmovement theabilitytoregulate ordirectthemechanismsessentialto movement motor c milestones  earlyphases infancy control 189T feed eat mobility afinemotorskills posture i prune head neckalignment canperson comeupagainstgravity proximal stability leads to distalmobility dysfunctionalmovement patterns MultisystemsEfftional is involvement in multiplestructures w the CNS PNS to generate modulatemotoroutputmovemen ftp.ere a patientreaches for a glass ofwater using fMRI youcanseeareas ofthecortexspinalcord PNSalllight DynamicSystemsTheory Entrypoint basisof theory is constantchange win multiplesystems 84 It em will affectanother system environment cognition Tasteit selforidesmotivation elicits systemrequirements musculoskeletalsensorycognitiveneurological emotional 9 initiatesmovement forvoluntarymotormovement Neuromuscular system executesthemovement Environmffentates orinhibitsmovement Exlearninghow to ridebike environ.IS aynduggffefeedbacu is kidgetting typeofbike social beingtaught who'swatching Principles of motorcontrol what to considerwhentreatingmotordysfunction Natural Issible wheretheynormallydoit practicethe occupation meaningful task Physicalconsiderations muscletone hyperhypotonicity strength endurance howlong degrees Limiting offreedom Fixjointinoneplaceforsupportelbowontable to doless won  MotorLearning g acquiremotorshills L presentation oftaskforlearning type of 9 Hera bilateral Ihand bothhands simple mspecific type aim blocked If doingpartoftasurepetitive 0doingotherthingslikethat amount Iff visual pPfeffer complete w colorstexture gesture proprioceptive Standsitdifferentchair vestibular eventually wantto giveless less timingof feedback taskconsiderations fortreatment activeinvolvement makesure engagedfacilitatedoingthemselves actively If Inmedicine mentalrehearsalpractice tocomplex floatingsomething thenactuallydoingit samethinglightsup mom planningpray Estart in primary motorcortexin frontallobe M primary somatosensory infrontof parietallobe Pra theabilitytounderstand implementmovements for aspecificactivity is If Imputemotor tasu in coordinated way Ideomotor to accessmotorplan putitintoaction tent is unable to useRUEto combhair Ideation at cognitiveunderstandingof motor demands for a specificfunction impropertooluse couldmixupmotor plan Expatient is unabletosequencestepsofcombingtheir hair maypickupbrush bybristlesorusecomb to brushteeth LeftsideofBrain controlsrightsideofbody frontallobe primary motorcortex crossesoverat medulla Right I ff sideofbody StructuresInvolved in motorPlanning Control MotorPathway Begin inmffaplis accessed descendsw UMN Refinedmotor plan in the cerebellum basalganglia Descends CNS  impulse descends throughthe CNS spinalcord P theimpulse reaches PNS resulting in muscle contraction jointmovement Frontal Lobe Primarymotor area responsible for voluntary consciously initiatedmovement Whereideapraxia comesin Site of motor homunculus location I ro fofticofianal tracts Frontaleyefields function visual saccades jumpingfromone to another Basa GILL madeupof interconnected nuclei voluntarymusclemovement to achieve precisioncontrolinbody movements headeyes handswhengraspingobject arm swing anuprighttrunkbalancewhenwalking handeyecoordination coordinatingbalance right left alternating movements regulategoaldirectedbehavior social emotionbehavior role in if PEE fainperstia during social interactions Role in oculomotor control head neckmovement Regulation of muscletone hypo hypertonicity Balancefromwin 3Neurotransmittersproduced byBG GABA inhibitoryeffect on cortex Acetic Ifatory oncortex Pant citatory inhibitory depending on whereit binds bindingw CNSassist w cognitiveprocess learning memory bindingw PNScommuniation between nerves muscles Basal GangliaLesions imbalance of neurotransmitters affecting corticalfunctions difficultyinitiatingcontinuing or stoppingmovement needverbal feedback problems w muscletone rigidity increased involuntary undesired movements tremor chorea BasalGangliaDisorders Hemi bailiffsmovements on 1 side violent thrashing of contralateralextremity Ballismifbiffer lesion merges w hemichore  Athe ow flaing of upper lowerextremities continuous movements slowaimless purposeless movement twisting or turningquality continuous prolongedcontraction of agonist antagonist Hokkethan chorea Chorea suddeninvoluntary jerkdancelive movements axial proximallimbareas Facial grimacingeyebrowraisingeyerolling tongue protrusion associated w movements moreHIIF.gefafeddiseffninuingaboutit twistingrepetitive movementsresult in abnormalpostures muscle contractions can last seconds to hours can eventually causejoint degradation occurs in limbsfaceneck trunk Tardive Dyskinesia disorder occursafterchronic useof drugs blockdopaminereceptors Choreiform movements dystoniatics myoclonus jerkingmovements Tongueprotrusionchewingtypemovementsfacialgrimacing Parkinson's Disease lip smacuingeyemovement reduction in production of dopamine movementslows mentalprocessesbecomedelayed Hypertonicitycogwheel rigidity bradyuinesia masulinefacecloseabilityto emotes tremors at rest difficultyinitiating stoppingmovementlossof arm swing impaired postural reflexes micrographiaCsmhandwriting depression anxiety cognitive changes TouretteSyndrome If if28 8affects maleforfemale genetic component morethen ur persists due to increasedsensitivity to dopamine Tremor involuntaryoscilating movements essentialtremor 7tremorgetsworsewhenthey go to reach gets worse as they get to target restingtremorwhen at rest Tics repetitive Idp involuntary conscious movements purposeless movements vocalIEcholalia cerebella functions Is.fi sfcEaffff cepffrefuL's inP'm kaputbackdownthe spinalcord to movement produce  refinemotor movement the sensoryproprioceptiveinput from periphery the cerebellum could not play a major a n in smoothmovement gross movements of limbs finedistalmovement vestibularsystem Tone hoffatffvements equilibriumpostural control cerebelfsfdfaffpasam.ge adgofga dy presentation leftside left side dorsal columns proprioception Hypotonia hyporeflexia methability to judgedistance over undershooting Disdiadochokinesia inability torapidly alternatemovements down nf moveme ffmpfs.in smoothmovementcoordination Intention occursduringmovements tremor as soon as they use arm stacca Ee Speaumodulation proprioception choppy speech BrainstemInjury Primitive reflexes midbrain pons medulla Primitive n fetaldevelopment Infant brushteeth turnmouth n'ftp havekhenffoimprovemotor movement impairment or damage to brainstem whatweretheylivebefore Bothsignsindicate corticospinaltractlesion in brainstem if present in adulthood Babin fff.IEensffeefbaEi toes2 5 adultpresentation lesion maynot Hoffmann flicking nail digit 3 midfiffersitiveradductionthumbdfennigit torian ffff.am during an  Forhypertonicity Procedure anPROM quickstretch toneis Te dependent onlyhavetoneif we cando itquick Slowhelps tone decrease for hypertonicity Grade Description Noincrease in muscletone 0 I 2 3 i898 adf.IEttemynout me 4 In meantmafia affectedpartrigid in flexion 5 extension Dysdiadochokinesia rapidalternatingmovements Bilateral pronation supination only dooneside Intention 9mor dysmetria finger Nose finger R L middle wandering ormiss Nystagmus cover in cranialnervelab present at endof ROM Dysarthria observation ofspeech staccatovoice Ataxia Romberg's Incetest 1 1 11891with Tonite in pushing differentdirections put feet mayfall together out of baseof support Basal Ganglia Screening Observation at rest thenduringactivity resting tremor Auinesia or bradykinesia Chorea athetosis Hemi ballismus dystonia PROM OMAS rigidity Coordination Assessments manualdexterity ahole 85kfest test  Jebson TaylorHand functiontest OConnor fingerdexterity tweezertest purdue peg board ii i iiiie n mail.in as therapists we provide treatment to enhance neurological functionacross the lifespan 3 mechanisms in CNS ftp.yyygatterntgat forms in neurons a decrease in responseto a given stimulus Iff thatc ifeng.ecEesfhiisitewtrenabidesensitiea canbecomeless sensitive to touch or temperature whengradu 98 8 8 mfrs enefits from desensitization Experience Depend af.ci a lengthy process to strengthen orweaken connectionsbetweenneurons dueto experiencehowbrainis organized Initiallyduringmotorlearninglargeareas of thebrainareactivated Intimetheareas of thebrainthatare activated are smaller morespecific because we becomemorefamiliar precise here n'in freq eventually I listened ftp.actifnaafonsu Recovery end elements of neurologicalinjury injury to cellbody of neuronresults in celldeath axonof theneuron can result in a portion of theneuronsregenerate Hyptwang mechanismfortical reorganization neuronsmakenewaxonalconnections to compensate forneuronal lossdueto an injury cantakeyears images patients to recieverehabpostinjuryto enhancethis pegged for Neurogenesis stem cells traveltositeofinjury to assist w creation of newneurons unfortunately mostdiedue to inflammation surrounding injury dependent onintensity timing ofrehab as an injurydependentmodel thequality quantity ofneurorehab a stroke or braininjured patient connections im t softly mygnf.de fffns whatdoesthismeanfor OTintervention if youdon'tuse ityouloseit cortical representation on homunculi areusedependent otherareascantake over cortical representation if a bodypartlosesfunction oncecortical arearepresenting specificbody partis gonethepersonmustrecreate it makenewneuronal connections or newneurons