Peripheral
nervous system (PNS)
The peripheral nervous system consists of the set of
nerves and nerve ganglia. Nerves are called nerve fiber bundles that are
outside the neuraxis, ganglia, a cluster of nerve cells interspersed throughout
the course of the nerves or roots. Although it is also peripheral sympathetic
nervous system (also called vegetative or autonomic) is considered as a
different entity that transmits nerve impulses only related visceral functions
that take place automatically, without influencing the subject's will
Exploring Reflections
The reflections are
obtained percussing with a reflex hammer and wrist movement, tendon or a bone
protrusion, this stimulation causes muscle stretch, responding with a sudden
contraction.
Basic principles for exploration:
- They use the reflex
hammer.
- Keep the hammer
between thumb and forefinger.
- The blow must be
direct and fast (not oblique).
- The member to be
examined must be relaxed.
- The stimulus must be
of equal intensity on both sides.
- Compare speed,
strength and breadth of the response on both sides.
- Do not use more force
than necessary to get an answer.
- In case of difficulty
using the response for reinforcement , this is an isometric contraction of other
muscles that increase reflex activity.
The reflections measured in
degrees along a scale of 0 to +4:
- +4 Hyperactive, very sharp.
- +3 Faster than average.
- +2 Average normal response.
- +1 Slightly decreased.
- 0 no reply.
Main reflections to explore:
It integrates core level in segments C5-C6. Is explored with the
patient's arm flexed at the elbow with the palm down, then builds a thumb or
finger on the biceps tendon is struck with the reflex hammer so that the blow
is transmitted through Toe browser to the biceps tendon, the expected response
is appreciated elbow flexion biceps muscle contraction.
Is integrated at the level of C6-C7 spinal cord segments. The way to explore
is to flex the patient's arm at the elbow, palm facing the body, then proceeds
to striking the triceps tendon just above the elbow. The expected response is
the extension of the elbow with triceps muscle contraction. It is sometimes
difficult to get the patient is completely relaxed, here you can hold the upper
arm, asking the patient to relax, then beats the triceps tendon.
It integrates into the spinal segments C5-C6. The
patient's hand resting on the abdomen or in the lap , with the forearm in pronation partial, then the radius bone is struck
from 3 to 5 cm. above the wrist, the expected response is the flexion and
forearm supination.
It explores with the patient sitting or lying down with the knee flexed
and relaxed. It
beats the femoral quadriceps tendon just below the kneecap , is expected to knee extension with quadriceps contraction. It is
generally carried out with the patient seated, leaning on the contralateral
thigh. With the patient supine can use two methods, the first is to hold both
knees together and subsequently be striking the patellar tendon, explore a
reflection and then the other repeatedly, and thus calculate small differences,
but holding both legs sometimes uncomfortable for the clinician, an option in
which the examiner's arm rests on the opposite leg.
The reflection is integrated mainly at S1. It explores some leg bent at
the knee, performing a dorsiflexion of the foot from the ankle and beats the
Achilles tendon, the expected response is plantar flexion at the ankle.
The reflex center is located at the level of L5-S1 spinal segments. The
scan form is touching to an object (applicator, key, etc.), The lateral surface
of the plant in an upward direction from the heel to the metatarsophalangeal
joint, and medial curve direction through the pad above, the response expected
is flexion of the fingers.
Cutaneous abdominal
reflexes.
The abdominal reflexes are explored on each side of the abdomen,
touching the abdominal wall with a sharp object above and below the navel
(spinal segments T8-T9-T10 and T10-T11-T12, respectively) from the outside in,
the answer is expected contraction of the abdominal muscles and deviation of
the umbilicus toward the side stimulated. In obese patients must retract the
patient's navel in the opposite direction from side to stimulate the finger
retracts perceive muscle contraction in this case.
SURFACE REFLECTIONS O
cutaneous and mucosal
The sensory receptors of
the skin and subcutaneous tissue respond to touch, pressure, heat, cold and
injury. These receptors produce signals that result in a level of the spinal
motoneurons and interneurons, these are responsible for getting information to
higher centers to issue a specific response.
• Plantar reflex. -
The subject must be examined in the supine and the leg extended. It touches the
foot on the outside from the heel up with a blunt object. The answer you get is
plantar flexion of the fingers.
• Triceps surae reflex.
- It stimulates the skin by rubbing the calf, making the contraction
response muscle and the extension of the foot.
• Cutaneous abdominal
reflexes. - It rubs the skin of the belly from the side toward the midline
with an object sharpening or edge of one. The underlying muscle contraction
moves the abdominal wall and drags the navel toward the side stimulated. For
upper abdominal reflex is stimulated below the costal margin and the reflection
lower abdomen above the inguinal crease.
• Cremasteric reflex and
reflex in the female counterpart. - In the male it stimulates the inner
thigh, where top, using a pin, sliding up and down gently, the response is the
contraction the cremaster the same side. With this technique in women's
response is achieved abdominis contraction greater.
• Conjunctival and
corneal reflex. - Are explored touching the cornea or conjunctiva with a
cotton ball or blowing slightly in the eye open. The normal response is abrupt
occlusion of the eyelids indicating that both the branch sensory (trigeminal
nerve) and the motor branch (facial nerve) are not affected.
• Pharyngeal reflex. -
With the tongue depressors proceeds to stimulate the posterior pharyngeal wall,
the answer will be your shrinkage sometimes produces feelings of nausea.
• Velar reflex. -
Encouraging the free edge of the soft palate with tongue depressors its
elevation is observed which is normally uniform.
• Nose or sneeze reflex.
- Is achieved by introducing a tissue in the nose. The answer is sneezing
accompanied by watering. This reflex is also achieved by pulling on the villi
of the nasal wall
MUSCLE STRETCH REFLEX OR
DEEP
Incorrectly referred to as
ROT tendon or that result from stimulation of muscle spindle, for level stretch
the fibers of the muscle belly, bone and tendon tension are mere transmitters.
The deep reflexes are
obtained with the hammer percussing reflexes, by a quick hit and soon applied
to a tendon. This stimulus produces a stretch of the tendon that causes a
sudden muscle contraction. This response is expression of the stretch reflex or
stretching, in which the stimulus activates the receptors located the muscle
allowing it to present such a response. This contraction is present when the
muscle retains the tone. It has a muscle spindle afferents from the sensory
nerve to the core and from this, through a synapse modulated, the nerve root
and effector motor until the motor units. This long journey comprises a large
area of the nervous system and reflex defect translates several possible
anatomical locations
Biceps reflex. - The therapist should hold the patient's elbow in semiflexion, is struck
in the tendon and the answer will flexion of the forearm on the arm
Triceps reflex. - Take the arm with one hand at the elbow dropping the forearm at right
angles, is beats the triceps tendon and is obtained as a result of extension of
the forearm on the arm
Reflection estiloradial or
brachioradialis. - To produce this reflex is
placed in the upper forearm flexed on the arm, so that the ulnar forearm rests
on the therapist and proceeds to strike the radial styloid process, the answer
is flexion of the forearm. The answers accessory are
slight supination and flexion of the fingers
Reflection cubitopronador.
- In the same position as
before, is struck the ulnar styloid process, the answer
forearm pronation with slight adduction.
1. SURFACE REFLECTIONS O cutaneous and mucosal
The sensory receptors of
the skin and subcutaneous tissue respond to touch, pressure, heat, cold and
injury. These receptors produce signals that result in a level of the spinal
motoneurons and interneurons, these are responsible for getting information to
higher centers to issue a specific response.
• Plantar reflex. -
The subject must be examined in the supine and the leg extended. It touches the
foot on the outside from the heel up with a blunt object. The answer you get is
plantar flexion of the fingers.
• Triceps surae reflex.
- It stimulates the skin by rubbing the calf, making the contraction
response muscle and the extension of the foot.
• Cutaneous abdominal
reflexes. - It rubs the skin of the belly from the side toward the midline
with an object sharpening or edge of
one. The underlying muscle contraction moves the abdominal wall and drag the
navel toward the side stimulated. For upper abdominal reflex is stimulated
below the costal margin and the reflection lower abdomen above the inguinal
crease.
• Cremasteric reflex and
reflex in the female counterpart. - In the male it stimulates the inner
thigh, where top, using a pin, sliding up and down gently, the response is the
contraction the cremaster the same side. With this technique in women's
response is achieved abdominis contraction greater.
• Conjunctival and
corneal reflex. - Are explored touching the cornea or conjunctiva with a
cotton ball or blowing slightly in the eye open. The normal response is abrupt
occlusion of the eyelids indicating that both the branch sensory (trigeminal
nerve) and the motor branch (facial nerve) are not affected.
• Pharyngeal reflex. -
With the tongue depressors proceeds to stimulate the posterior pharyngeal wall,
the answer will be your shrinkage sometimes produces feelings of nausea.
• Velar reflex. -
Encouraging the free edge of the soft palate with a tongue depressors its
elevation is observed which is normally uniform.
• Nose or sneeze reflex.
- Is achieved by introducing a tissue in the nose. The answer is sneezing
accompanied by watering. This reflex is also achieved by pulling on the villi of
the nasal wall.
2. MUSCLE STRETCH REFLEX OR DEEP
Incorrectly referred to as
ROT tendon or that result from stimulation of muscle spindle, for level stretch
the fibers of the muscle belly, bone and tendon tension are mere transmitters.
The deep reflexes are
obtained with the hammer percussing reflexes, by a quick hit and soon applied
to a tendon. This stimulus produces a stretch of the tendon that causes a
sudden muscle contraction. This response is expression of the stretch reflex or
stretching, in which the stimulus activates the receptors located the muscle
allowing it to present such a response. This contraction is present when the
muscle retains the tone. It has a muscle spindle afferents from the sensory
nerve to the core and from this, through a synapse modulated, the nerve root
and effector motor until the motor units. This long journey comprises a large
area of the nervous system and reflex defect translates several possible
anatomical locations.
• Biceps reflex. -
The therapist should hold the patient's elbow in semiflexion, is struck in the
tendon and the answer will flexion of the forearm on the arm.
• Triceps reflex. - Take
the arm with one hand at the elbow dropping the forearm at right angles, is
beats the triceps tendon and is obtained as a result of extension of the
forearm on the arm.
• Reflection
estiloradial or brachioradialis. - To produce this reflex is placed in the
upper forearm flexed on the arm, so that the ulnar forearm rests on the
therapist and proceeds to strike the radial styloid process, the answer is
flexion of the forearm. The answers accessories are slight supination and
flexion of the fingers.
• Reflection
cubitopronador. - In the same position as before, is struck the ulnar
styloid process, the answer forearm pronation with slight adduction.
In lower level evaluate the
following structures:
• Or patellar knee jerk.
- Is evaluated with the patient sitting on the edge of the couch with legs
suspension or with one leg crossed over the other. The stimulus is the
percussion of the patellar tendon, the answer is the extension of the leg.
• Reflection aquiliano.
- There are 4 different ways to evaluate this reflection:
1. Patient sitting on the
edge of the couch or chair, rising slightly the foot with one hand and is
struck ballasted the Achilles tendon.
2. Patient knees with your
feet off the edge of the stretcher is carried slightly forward of the foot and
is struck on the tendon.
3. In the supine position,
place the foot of the member to evaluate the opposite, one hand takes the floor
of foot dorsiflexion taking it lightly and performed percussion.
4. Patient lying down gets
the anterior region of the plant making the dorsiflexion of the foot, thus
stretching aquiliano tendon and performed percussion.
The answer to any of these
techniques is the extension or plantar flexion of the foot.
• Reflection
mediopubiano. - Patient supine with the thighs and legs ABD light and
slightly bent, is strikes it on the pubic symphysis, the answer is twofold: one
is higher than the contraction of muscles abdominal and lower approach
consisting of both thighs by the action of the adductors.
In the head:
• Reflection
nasopalpebral. - The stimulus is the percussion in the skin of her middle
frontal region between the two arches brow, the response is the contraction of
the orbicularis of the eyelids on both sides.
• Reflection ridge. -
Percussing superciliary arch occurs contraction of the orbicularis of the
eyelids of same side.
• Masseteric reflex. -
We ask the patient to open his mouth and strikes it on the chin, or you will
introduces a spoon with the handle resting on the arch of the patient and is
performed on the stimulus handle, the answer in both cases is the elevation of
the mandible.
The reflexes are automatic movements that are
triggered by a stimulus. As their nervous systems mature, the baby is gaining
voluntary control of muscles and reflexes lost or forgotten. Among those seen
at the first examination of the newborn include those discussed below.
Are the movements made by
the child's mouth in all directions,
when stimulated its outline gently with your finger.
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explored by introducing a pacifier or
nipple in the mouth. Normally the child makes sucking motions.
He stimulates the palm with a finger. The boy flexes his fingers and
grabs him with great force.
4.Tonic-flexor synergy of the hand
He stimulates the palm with a finger. The boy flexes his fingers and
grabs him with great force.
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Stimulates the plant of one of the feet. The contralateral limb, which
remains free, responds in three phases: flexion, extension and adduction
(approaching the midsagittal plane of the body).
By giving a gentle tap below the kneecap,
the little leg stretched involuntarily.
7. Tonic neck
The child should be
at rest, face up. If you have the head turned to the right, have the right arm and
left knee bent.
The reflections of
the stairs, straightening of the trunk with plantar support and automatic
operation are explored sequentially.
This is done by
holding the child under the arms and comes close to the edge of a table. The baby will try to come up with
both feet is that the step edge.
When both plants
contact with the surface, tighten the
muscles of the legs and trunk straightening the body.
Finally, to incline forward, give a series of steps.
9.-Prehension
plantar réflex: The baby flexes toes
when stimulated with a finger on the basis of the same.
10. Reflecting the range or extent of the
fingers: Also occurs in the foot. By
stimulating the ground, fingers
extended and separated.
BACK
PAIN
It is known as back pain,
one that is located in the area between the lower rib cage and the sacral
region, and that can sometimes compromise the buttocks.
A large percentage of
patients have what is called sciatica. In this case the pain radiating distal
to the lower limb, corresponding to the distribution of the lumbosacral nerve
roots, with or without sensory or motor deficit.
The causes of most back pain acute and chronic
predisposing individual workers, are genetic alterations in the biomechanics of
the spine, caused by poor posture at work and outside it, muscle weakness,
especially abdominal ligaments and tendons shortened by shrinkage chronic
mechanical overload and inflammation of the posterior joints with varying
degrees of osteoarthritis aggravated by inadequate and unusual efforts, work in
the same position usually sitting, inappropriate use of chairs and a high
degree of stress.
Acute pain in pathological
conditions is due to the abrupt change of the vertebral structures with their
immediate consequences of edema, release of histamine and bradykinin (halogen
substances) and reflex muscle spasm.
Chronic pain is more
complex because it involves a series of events that somatic and psychological
make up a chain of factors that can maintain. These include emotional stress,
physical trauma, infections, etc.. The pain causes muscle tension and this
triggers both ischemia, edema, release of algogenic substances and
inflammation. The latter causes an elongation limitation of joint mobility,
leading all functional disability, forming a vicious circle in which the organic
and psychological factors overlap or pain may continue indefinitely.
The most common situations
that perpetuate this pain behavior are: the attention and sympathy from family
and friends, the use of drugs that suppress unpleasant affective states, and
exemption of major responsibilities: work, sex or cause anxiety.
After the head, lower back
is one of the sites where, more often, there is pain. Same as headache, back
pain is the expression of a large number of local or remote causes that are
expressed muscle spasm and pain. In response to a state of emotional imbalance
and acute or chronic tension.
Although the causes of back
pain are numerous only in two forms: acute low back pain and chronic low back
pain.
