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Chapter 3: Neuromuscular Physical Therapy

Kristen Johnson; Heather David

ANATOMY AND PHYSIOLOGY OF THE NERVOUS SYSTEM

OVERVIEW

The nervous system is divided into the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS contains the brain and spinal cord, while the PNS involves the spinal and cranial nerves and ganglia, the autonomic nervous system. Understanding neuroanatomy is critical to understanding brain functioning. Figure 3–1 illustrates the gross anatomical divisions of the CNS.

FIGURE 3–1

Gross anatomical divisions of the CNS. The cerebral hemispheres are found at the rostral end of the nervous system. The basal ganglia are contained within the cerebrum. The midbrain, pons, and medulla oblongata together are called the brainstem, and caudal to that is the spinal cord. Rostral to the midbrain is the diencephalon, the thalamus, and hypothalamus, which together with the cerebrum is called the forebrain. In this scheme (forebrain, midbrain, and hindbrain), the midbrain is itself, and the hindbrain is the pons, medulla, and cerebellum. (Adapted with permission, from Kandel ER, Schwartz JH, Jessell TM, Siegelbaum SA, Hudspeth AJ. Principles of Neural Science, 5th ed. New York, NY: McGraw-Hill; 2013, Box 1-1, Pg 9.)

An illustration shows the anatomical divisions of the central nervous system.
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High-Yield Terms to Learn
Neuroplasticity An emerging body of research evidence to support the hypothesis that brain remodeling throughout life is possible and is enhanced by the type and amount of practice related to skill acquisition.
Neurologic examination An essential component of a comprehensive physical examination, and includes the systems review and a comprehensive and systematic examination of both the central and peripheral nervous system in conjunction with other body systems. The examination should determine impairments in body function and structure, limitations in functional activities, and participation restrictions.
Cerebrovascular accident/stroke Occurs when there is interruption of blood flow within brain blood vessels, which can be a narrowing or blockage of the vessel (ischemia) or can be a rupture of a vessel (hemorrhage).
Traumatic brain injury (TBI) Can result from a blow to the head and/or sudden acceleration–deceleration of the head, such as in motor vehicle accidents. TBIs can be closed or open, in terms of whether or not the skull is fractured.
Mild TBI mTBI) A brain injury that causes microscopic damage that may not be detectable on neuroimaging and may or may not involve a loss of consciousness.
Brain tumor A mass or growth of abnormal cells in the brain.
Spinal cord injury (SCI) An injury most commonly when there is fracture, dislocation, and/or subluxation of the vertebrae into the spinal cord.
Multiple sclerosis (MS) A chronic, progressive, inflammatory disease that affects neurons in the central nervous system.
Parkinson’s disease (PD) The second most common, progressive neurodegenerative disorder with deficits in the basal ganglia and its connections to motor, cognitive, and psychiatric functions.
Huntington’s disease (HD) A progressive neurodegenerative disorder caused by an autosomal dominant mutation where there ...

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