Module 2: Understanding the Neonate & Young Infant Flashcards
1
Q
Three fundamental functions of the Brainstem?
A
- Source of Cranial Nerves
- Modulation of Ascending sensory tracts & descending motor tracts
- Regulating autonomic functions, primitive reflexes, level of consciousness
** Apgar score = BS score/ assessment
2
Q
Reticular Formation
A
- Central core of BS
- Integrator of CNS
- contains neurotransmitter system; nuclei that produce neurotransmitters
- The lateral zone of the reticular formation receives afferent input through the spinoreticular
tract, whereas the medial zone sends efferent projections through the reticulospinal tract.
Together, these systems work to maintain muscle tone and postural stability.
3
Q
PAG (Periaquaductal grey matter)
= In mid brain
A
- Powerful producer of endogenous opioids
- Powerful Pain inhibitor - descending pain control
- Influenced by wind up in mecencephalon
- People that have high wind up in mesencephalon/ midbrain = pain dampening system isn’t working well = more sensitive to pain
4
Q
9 functions of the PFC
A
- Regulate body - SNS and PNS balance
- Tune-in to someone - their internal experience
- Affect regulation
- Response flexibility
- Calm fear
- Empathy
- Insight
- Intuition
- Morality
5
Q
Dopaminergic Systems:
A
- Dopaminergic cell bodies in Substantia Nigra = important role in control of movement
- Dopamine from VTA has pivotal role in Motivation, Reward, Addiction, Emotions, Executive function (memory & decision making)
- L brain = more dopamine receptors
- L brain = get me up, drive me fwd, reward, planing, dead lines, ambitious
6
Q
Noradrenergic Systems
A
- Locus Coeruleus (in reticular formation)= Cluster of Neurons using Noradrenaline as principle neurotransmitter
- Project to forebrain or SC
- Noradrenergic system modulates = arousal (sleep/ wake), attention, mood, pain
- activity/ firing of these noradrenergic
neurons can be either tonic, or
phasic - The tonic firing of LC neurons determines our
general level of arousal and attention through
projections to the CNS. NE helps synapses
work more effectively - A phasic increase in LC firing happens when
attention needs to be directed to a specific
stimulus. This phasic firing helps us to focus
our attention on a specific task while
suppressing distracting stimuli (NE has both
stimulatory and inhibitory neuromodulatory
functions) - Noradrenergic signaling has been
implicated in many disorders related to
attention, arousal, and mood. (ADHD, PTSD, Sleep disorders)
7
Q
Serotonergic Systems:
A
- Serotonergic neurons in the brainstem
are located in the raphe nuclei, a
collection of neurons in the midline
along the entire length of the brainstem
and spinal cord - Serotonergic neurons send out widespread projections that influence mood, appetite, sleep- wake states, pain, aggression, cognitive functions (Memory & Learning)
- Serotonergic signaling has been established in the central modulation of pain.
Descending fibers from the raphe nuclei directly modulate pain transmission in the
posterior horn of the spinal cord - warmth/ heat can stimulate production of serotonin
8
Q
Cholinergic Neurons:
A
- neuromodulatory role by
enhancing the functioning of synapses - Cholinergic projections to the thalamus
appear to strengthen the excitatory
output from the thalamus to the cortex
and, thereby, play an important role in
arousal and motor function.
9
Q
Histaminergic Neurons:
A
- Projections of histaminergic neurons
appear to play a role in general arousal
and alertness - Antihistamine drugs that can cross the
blood–brain barrier and block central
histamine release cause drowsiness.
10
Q
Clinical Brainstem Assessment
A
- General degree of alertness and calming
- ANS (mesencephalon drives IML drives SNS)
- Sleep/wake cycles
- Posture
- Tone (reticulospinal)
- Primitive Reflexes
- Cranial Nerves
11
Q
Tone Assessments
A
- Horizontal suspension
- Vertical suspension (shoulder girdle tone)
- Scarf Sign
- Hip/ knee tone = Foot to head (check knee extension
- Ankle DF
- Head control w pull- sit (should hold head level @ 2-3 months)
- MSR
- Can bub lift head whilst prone?
- doughy-ness of muscles/ calf
- W sitting? (midline cerebellar issues)
12
Q
Galant
A
- Int 2-4 months
13
Q
Moro
A
- Int 3-6 mo
14
Q
ATNR
A
- Int 6-10 mo
15
Q
Cranial Nerve Screening
A
- Pupil reflex - CN II (optic N detect ligt, oculomotor N constrict - edingar westphal nucleus - cillary bodies)
- Doll’s eye - CN III, IV, VI
- Corneal, sucking, rooting - CN V, VII
- Response to noise - CN VIII
- Gag reflex - CN IX, X
