• Group Members

• PHT/20/2794
• PHT/20/2617
• PHT/19/2250
• PHT/20/2790
• PHT/20/2783
• PHT/20/2801
 OUTLINE
• INTRODUCTION
• CLINICAL ANATOMY
• TYPES
• FUNCTIONS
• PHYSIOLOGY OF NERVE IMPULSES
• INJURIES TO THE NERVOUS SYSTEM
• CLINICAL RELEVANCE TO PHYSIOTHERAPY
• NEUROREHABILITATION
• RECENT ADVANCEMENT IN NEUROREHABILITATION
• CONCLUSION
 INTRODUCTION
• The nervous system is a complex network of cells and organs
responsible for transmitting signals throughout the body, allowing it to
respond to internal and external stimuli. It is divided into two main
parts: the central nervous system (CNS), which consists of the brain
and spinal cord, and the peripheral nervous system (PNS), which
connects the CNS to the rest of the body. The nervous system plays a
crucial role in processes such as sensation, movement, cognition, and
regulation of bodily functions (Kandel et al., 2021). Understanding its
structure and functions is fundamental to comprehending how the
body maintains homeostasis and interacts with the environment.
CLINICAL ANATOMY
• The nervous system has two major
anatomical divisions

• The central nervous systen(CNS)

• The peripheral nervous system(PNS)

SUBDIVISION OF THE NERVOUS
SYSTEM
CENTRAL NERVOUS SYSTEN
• The CNS consists of the brain
and the spinal cord
• CNS protected by a cranium
sorrounding thr brain and
vertebral column sorrounding the
spinal cord
• CNS is bathed is cerebrospinal
fluid and is composed of grey
and white matter
THE BRAIN
• The brain is semi-sperical but soft delicate complex organ
• It is the center for control and integration
• An adult brain weighs near 1.5kg
• Average about 1600g in men and 1450g in women
• Composed of an estimated 100billion neurons
• Anatomically the brain is divided into 3 regions
• Forebrain
• Midbrain
• Hindbrain
• The brain is lined by membrane called meninges.
• The brain is conspicuosly marked by surface gyri(folds) and
sulci(grooves)
• The human brain is composed of neurons, glial cells and blood
vessels.
• It also consists of fout internal interconnected chambers called
ventricles.
ANATOMY OF THE BRAIN
FOREBRAIN
• Forebrain consists of the following regions; Telencephalon(cerebrum)
and Diencephalon(Thalamusm, hypoyhalamus, epithalamus and
pituitary gland)
• The cerebrum is the largest part of the brain
• It is divided into two hemispheres separated by the longitrudinal
fissures
• The hemisphere are prominently market with gyri and sulci
• Each cerebral hemisphere is subdivided by deep sulci or fissures into
the five lobes: Frontal, Parietal, occippital, Temporal
MIDBRAIN
• The midbrain is a short section of the brain stem between the
diencephalon and the pons.
• A short segment of the brainstem that connects the hindbrain abnd
forebrain
• Within the midbrain is the cerebral aqueduct(aqueduct of sylvius)
• It includes important centers for vision, hearing, pain, and motor
control.
ANATOMY OF THE MIDBRAIN
HINDBRAIN
• The embryonic hindbrain differentiates into two subdivisions, the
metencephalon and myelencephaloaspect of the cranial can
• The metencephalon is the most superior portion of the hindbrain.
• The pons which measures about 2.5cm long, forms a broad anterior
bulge in the brainstem just rostral to the medula
• It conducts signals up and down the brainstem and between the
brainstem and cerebellum
• The cerebellum is the largest part of the hindbrain and receives most of
its input by the way of the pons.
• Occupies the inferior and posterior aspect of the cranial cavity.
ANATOMY OF THE HINDBRAIN
 SPINAL CORD
• It is an elongated cylindrical structure that is a ropelike bundle of nervous
tissue
• In adult , it averages about 1.8cm thick and 45cm long
• It begin as a continuation of the medulla oblongata at the level of the foramen
magnum
• The spinal cord serves three principal functions: Conduction, Locomotion,
and Reflexes
• The cord gives rise to 31 pairs of spinal nerves. The part supplied by each pair
os spinal nerves is called a segment
• The spinal cord is divided into cervical, thoracic, lumber, and sacrakl regions.
CROSS-SECTIONAL ANATOMY
• The spinal cord consists of two kinds of nervous tissue called gray and
white matter.
• Gray matter has a relatively dull color because it contains little myelin
• It has butterfly or H-shaped in cross sections
• It contains the somas, dendrites, and proximal parts of the axons of
neurons.
• It is the site of synaptic contact between neurons (information
processing)
• White matter contains an abundance of myelinated axons, which give it a
bright, pearly white appearance.
• It is composed of bundles of axons called tracts or fascicule
• It carry signals from one part of the CNS to another
• The spinal cord has two tracts; Ascending and descending tract
• Ascendind tract carry sensory information up the cord and descending
tracts conducts motor impulses down.
ANATOMY OF THE SPINAL CORD
CELLS OF THE NERVOUS SYSTEM
• There are two cells of the nervous system. The are;
• Neuron
• Neuroglia

• The functional unit of the nervous system is the nerve cell, or neuron.
• Neuroglia or glial are supportive cells in the nervous system that aid
the function of neurons.
NEURONS (Nerve cells)
• Neuron have three fundamental physiological properties
• Excitability
• Conductivity
• Secretion

• A typical neuron is divided into three parts

• Soma or cell body(perikaryon)
• Dendrites
• Axon
STRUCTURE OF A NEURON
 Types of Nervous System

• The nervous system is a highly complex and intricate

network of cells that coordinates the actions and
responses of the body. It allows organisms to perceive
their environment, process sensory information, and
control motor functions.
The nervous system can be broadly categorized into two main types based on its
structure and function:

The Central Nervous System (CNS):

The CNS is made up of the brain and spinal cord.
I)The brain is the control center for interpreting sensory input, storing
memories, and controlling thoughts, emotions, and higher cognitive functions.
The brain is divided into several regions, including:
•Cerebrum: Responsible for higher brain functions such as reasoning, sensory
perception, voluntary movement, and language.
•Cerebellum: Coordinates voluntary movement and balance.
Brainstem: Includes the medulla, pons, and midbrain, and is responsible for
basic life functions such as heart rate, respiration, and reflexes.
•Diencephalon: Includes the thalamus (sensory relay center) and
hypothalamus (regulates homeostasis, including temperature and hunger).

The spinal cord: The spinal cord acts as a conduit for signals between the
brain and the peripheral nervous system. It also controls simple reflex actions
independent of the brain, known as spinal reflexes.

FUNCTION :
•Processing information: The brain processes sensory data and sends out
appropriate motor commands to muscles and glands.
•Cognitive functions: Includes learning, memory, emotion, and decision making
•Regulation of homeostasis: The brain and spinal cord
play a crucial role in maintaining balance in bodily
systems, such as regulating heart rate, blood pressure,
and body temperature.
The Peripheral Nervous System (PNS):
The PNS is made up of the somatic and autonomic nervous systems.
I)Somatic Nervous System (SNS): Controls voluntary movements and transmits
sensory information from the skin, muscles, and joints to the CNS. It involves
motor neurons that control skeletal muscles.
•Sensory Division: Carries sensory signals from receptors to the CNS.
•Motor Division: Sends motor signals from the CNS to skeletal muscles

II)Autonomic Nervous System (ANS): Regulates involuntary bodily functions such

as heart rate, digestion, and respiration. It controls smooth muscle, cardiac
muscle, and glands. The ANS is further subdivided into:
•Sympathetic Nervous System (SNS): Prepares the body for "fight or flight"
responses, increasing heart rate, dilating pupils, and inhibiting digestion during
stress.
•Parasympathetic Nervous System (PNS): Promotes "rest
and digest" activities, slowing heart rate and stimulating
digestive processes to conserve energy.

•Enteric Nervous System (ENS): Sometimes referred to as

the "second brain," the ENS governs the gastrointestinal
system independently but also communicates with the
brain.
FUNCTION:
•Signal transmission: Transmits sensory information from the body to the CNS
and sends motor commands from the CNS to muscles and glands.
•Reflex actions: The PNS is involved in the processing of reflexes, some of
which are handled by the spinal cord without the need for brain involvement.
•Homeostasis: The ANS plays a significant role in maintaining internal stability
by regulating autonomic functions.
FUNCTION OF THE NERVOUS SYSTEM
[Link] Input:
•The nervous system gathers information from sensory receptors that detect
stimuli in the external environment (e.g., light, sound, touch) and internal
conditions (e.g., temperature, pH, blood pressure). These receptors are located
in the sensory organs (eyes, ears, skin, etc.).
Sensory signals are transmitted through sensory neurons to the CNS for
processing.

[Link]:
•The CNS processes sensory input and integrates it to form perceptions or
responses. For example, interpreting the sound of a bell or recognizing a specific
smell.
Integration also involves comparing new information with past experiences,
which enables decision-making, memory, and learning.
[Link] Output:
•After processing the sensory input, the CNS sends motor commands to muscles
and glands to carry out specific actions (e.g., moving a limb, secreting saliva).
•Motor output is carried out by motor neurons in the PNS, which convey signals
from the CNS to the appropriate target organs (muscles, glands).

[Link] and Homeostasis:

•The nervous system helps to maintain homeostasis by regulating involuntary
physiological processes like heartbeat, breathing, digestion, and body
temperature. This regulation occurs through both the sympathetic and
parasympathetic divisions of the ANS.
•The CNS also processes hormonal signals and integrates them with nervous
responses, influencing behaviors like eating, sleeping, and reproduction.
[Link] Functions (Cognition, Emotion, Learning, Memory):
•The brain is responsible for higher cognitive functions such as thinking,
reasoning, language, and problem-solving.
•Emotions are generated in various regions of the brain (like the limbic system),
and they help guide decision-making, learning, and social interactions.
•Memory storage and retrieval are carried out by the hippocampus and other
areas of the brain. Learning and memory involve complex processes such as
synaptic plasticity and neurogenesis.

[Link]:
•Reflexes are automatic, involuntary responses to stimuli, which are mediated
by the spinal cord or lower brain centers. For example, the withdrawal reflex,
where the body pulls away from a painful stimulus, happens without the brain's
involvement, ensuring rapid response times.
[Link] and Repair:
•The nervous system exhibits plasticity, meaning it can adapt to
changes in the environment or after injury. Neurons can form
new connections, especially in regions like the hippocampus.
However, the ability for repair is limited in the CNS, especially
when compared to the PNS, which has greater regenerative
capacity.
Physiology of Nerve
Impulses
The transmission of nerve impulses is a fundamental
process in the nervous system, allowing communication
between neurons and between neurons and muscles or
glands. This process involves both electrical and
chemical changes.
1. Resting Membrane Potential

The resting membrane potential is the difference in electric

charge across the plasma membrane of a neuron at rest. Typically,
it is about -70 mV. It results from the differential distribution of
ions (Na⁺, K⁺, Cl⁻) and the activity of the sodium-potassium pump
(Na⁺/K⁺ ATPase).The pump actively transports 3 Na⁺ out and 2 K⁺
in, maintaining a negative intracellular charge.
2. Action Potential

An action potential is a rapid, temporary reversal of the membrane potential.

When the membrane potential reaches a threshold of about -55 mV, voltage-
gated Na⁺ channels open.

Phases of Action Potential:

a. Depolarization:

Na⁺ channels open, and Na⁺ rushes into the cell.

The membrane potential becomes positive (up to +30 mV).

b. Repolarization:
Na⁺ channels close, and K⁺ channels open, allowing K⁺ to leave the cell.

The membrane potential returns to a negative value.

c. Hyperpolarization:

K⁺ channels remain open a little longer, causing the membrane potential to dip
below the resting level.

d. Return to Resting State:

Na⁺/K⁺ ATPase restores the resting membrane potential.

3. Propagation of Action Potential

Action potentials propagate along the axon by the opening of

voltage-gated Na⁺ channels in adjacent segments of the membrane.

In myelinated axons, the impulse travels faster due to saltatory

conduction, where the action potential jumps from one Node of
Ranvier to another.
4. Synaptic Transmission

At the synapse, the action potential triggers the release of

neurotransmitters (e.g., acetylcholine, dopamine) from the
presynaptic terminal.

These neurotransmitters cross the synaptic cleft and bind to

receptors on the postsynaptic membrane, generating a new
action potential or inhibitory response.
 Injuries to the Nervous System
• The nervous system, comprising the central nervous system
(CNS) and peripheral nervous system (PNS), is vital for
sensory input, motor output, and cognitive functions.
Injuries to this system can lead to temporary or permanent
impairments, depending on the severity and location of the
damage.
Types of Nervous System Injuries

1. Central Nervous System (CNS) Injuries

The CNS includes the brain and spinal cord. Injuries to the CNS
are often more severe because of its limited regenerative
capacity.
a. Traumatic Brain Injury (TBI): It can be caused by Blunt trauma,
penetrating injury, or sudden acceleration/deceleration of the head.

Effects: Concussion, contusion, intracranial hematoma, etc

b. Spinal Cord Injury (SCI)

Causes: Trauma (e.g., falls, car accidents), tumors, or infections.

Effects: Partial or complete loss of motor and sensory functions

below the level of injury
c. Stroke (Cerebrovascular Accident)

Cause: Ischemia (blockage of blood flow) or hemorrhage (rupture of a

blood vessel) in the brain.

Effects: Localized brain damage leading to motor, sensory, or cognitive

deficits.

d. Neurodegenerative Disorders
Although not caused by trauma, these disorders result in progressive
nervous system damage.

Examples: Parkinson’s disease, Alzheimer’s disease, amyotrophic

lateral sclerosis (ALS), and multiple sclerosis (MS).
2. Peripheral Nervous System (PNS) Injuries

The PNS includes nerves outside the brain and spinal cord.
Peripheral nerves have a better capacity for regeneration than CNS
neurons.

a. Peripheral Nerve Injury

Cause: Trauma, compression (e.g., carpal tunnel syndrome), or

stretching.

Effects: Loss of motor function, sensory deficits, and neuropathic

pain.
b. Brachial Plexus Injury

Cause: Stretching or tearing of the brachial plexus nerves during

childbirth or trauma.

Effects: Loss of arm and hand movement.

c. Bell’s Palsy

Cause: Inflammation of the facial nerve (cranial nerve VII), often

linked to viral infections.

Effects: Sudden, temporary facial paralysis on one side.

Diagnosis of Nervous System Injuries

Imaging Techniques:

MRI and CT scan for brain and spinal cord injuries.

Electromyography (EMG) and nerve conduction studies for peripheral nerve

injuries.

Neurological Examination:

Testing motor strength, reflexes, sensation, and cranial nerve function.

Prognosis

The prognosis depends on the type, severity, and location of

the injury, as well as the timeliness and quality of medical
intervention.

CNS injuries have a poorer prognosis due to limited neuronal

regeneration, whereas PNS injuries have a better recovery
potential.
Clinical Relevance to Physiotherapy
• The nervous system plays a crucial role in
physiotherapy, as it controls and coordinates
movement, sensation, and function.
• Here are some clinical relevance of the nervous
system in physiotherapy:
Motor Control and Learning

Motor control refers to the ability of the nervous system to

regulate and coordinate movement. Physiotherapists use
various techniques to improve motor control, such as:
- Exercise: Tailored exercises to improve strength, flexibility, and
coordination.
- Proprioception: Techniques to enhance proprioception
(awareness of body position and movement).
- Biofeedback: Using equipment to provide feedback on
muscle activity, helping patients adjust their movement
patterns.
Neuroplasticity

Neuroplasticity is the brain's ability to reorganize itself in response to

injury or disease. Physiotherapists can harness neuroplasticity to:

- Promote recovery: After stroke, spinal cord injury, or other

neurological conditions.
- Improve function: Enhance motor control, balance, and coordination.
- Compensate for deficits: Develop new movement strategies to
compensate for permanent damage.
Pain Management

Pain management is a crucial aspect of physiotherapy.

Physiotherapists use various techniques to manage pain, including:

- Exercise: Gentle exercises to improve mobility and reduce stiffness.

- Manual therapy: Techniques like massage, joint mobilization, and
soft tissue mobilization.
- Education: Teaching patients about pain management strategies,
such as breathing, relaxation, and pacing.
Sensory Integration

Sensory integration refers to the brain's ability to process and

integrate sensory information from various sources.
Physiotherapists use sensory integration techniques to:

- Improve balance and coordination: Enhance proprioception,

vestibular function, and visual processing.
- Enhance motor control: Improve movement patterns and reduce
clumsiness.
- Reduce sensory defensiveness: Help patients become more
comfortable with sensory stimuli.
Neuromuscular Control

Neuromuscular control refers to the ability of the nervous system to

regulate muscle tone and movement. Physiotherapists use various
techniques to improve neuromuscular control, including:

- Exercise: Strengthening exercises to improve muscle function.

- Electrical stimulation: Using electrical impulses to enhance muscle
contractions.
- Biofeedback: Providing feedback on muscle activity to help patients
adjust their movement patterns.
 PHYSIOTHERAPY IN NEUROREHABILITATION

Physiotherapy is an essential part of the

multidisciplinary approach in neurorehabilitation.
Neurological Conditions Treated;
1. Stroke: Rehabilitation focuses on motor recovery,
reducing spasticity, and improving gait and arm
function.
2. Traumatic Brain Injury (TBI): Enhancing cognitivemotor
coordination and functional mobility.
3. Spinal Cord Injury (SCI): Restoring as much
function as possible, improving independence, and
preventing secondary complications.
4. Multiple Sclerosis (MS): Managing fatigue,
spasticity, and balance deficits.
5. Parkinson’s Disease: Addressing rigidity,
bradykinesia, and postural instability.
6. Cerebral Palsy (CP): Enhancing motor skills
and reducing abnormal tone in children.
7. Peripheral Neuropathy: Restoring strength
and reducing sensory impairments
Physiotherapy Assessment in Neurorehabilitation:

1. Patient History: To understand the patient's medical

background, the onset of the neurological condition,
and any previous treatments or interventions.

2. Physical Examination: To evaluate the patient’s

overall physical condition, including musculoskeletal
and neurological status. Includes , Posture and
Alignment, Range of Motion, deformities, muscle
Strength, tone and spasticity, sensation, balance and
3. Functional Assessment: To assess how the
neurological condition impacts daily life activities,
mobility, and independence. Involves the use of scales
like the Functional Independence Measure (FIM) or
Barthel Index to assess the level of dependence for
activities of daily living (ADLs), gait analysis,
assessment of walking patterns and use of assistive
devices, Evaluating fine and gross motor skills.

4. Neurological Assessment: To evaluate the

integrity of the nervous system and understand
how the neurological condition affects movement.
Includes , cranial nerve Assessment, deep tendon
reflexes, pathological reflexes, clonus, sensory
testing, assesssment for deficits in proprioception,
5. Assessment of Cognitive and Emotional
Function

6. Spasticity and Pain Assessment: To measure the

level of spasticity and pain that may interfere with
movement and rehabilitation. Use of the Modified
Ashworth Scale to quantify spasticity in different
muscle groups, utilizing Visual Analog Scale (VAS)
or Numerical Rating Scale (NRS) to assess pain
intensity and it's effect on mobility
Interventions;
i. Spasticity Management: Stretching exercises,
passive range-of-motion exercises, splinting, and
functional electrical stimulation (FES).
ii. Strengthening Exercises: Resistance training to
improve muscle weakness.
iii. Neuromuscular Re-education: Facilitation
techniques like Proprioceptive Neuromuscular
Facilitation (PNF).
iv. Sensory Retraining: Tactile stimulation .
v. Posture and Core Stability Training: Postural
alignment exercises and core strengthening to correct
abnormal tone and alignment
vi. Task-Specific Training: Repetitive practice of activities
such as walking, grasping objects, or stair climbing to
improve motor performance.
vii. Gait Training: Treadmill-based training, balance exercises
for safe and efficient ambulation
viii. Balance and Coordination Training: Exercises using
unstable surfaces (e.g., balance boards) , swiss ball , one leg
stance or dynamic activities(bird dog) to improve postural
control.
ix. Assistive Technology: Use of walking aids (e.g., canes,
walkers), orthoses, or wheelchairs to support functional
independence.
x. Electrotherapy and Neuromodulation: Functional electrical
stimulation (FES) to activate paralyzed or weak muscles,
Transcutaneous electrical nerve stimulation (TENS) for pain
relief.
xi. Airway clearance: To help remove mucus and
secretions from the lungs and airways, especially in
patients with conditions that impair the ability to cough
or clear secretions effectively.
xii. Breathing exercises: To strengthen the respiratory
muscles, improve lung expansion, and increase
oxygenation.
Diaphragmatic breathing, pursed-lip breathing,Incentive
- spirometry(encourages deep breathing)
 Recent Advancement in
Neurorehabilitation
• The face of neurorehabilitation has progressively changed in
recent years.
• Recent advancements in neurorehabilitation have transformed
the field, offering new hope for patients with neurological
disorders. Technological Innovations have played a significant
role in this progress, including:
• Robotic-assisted training: Enhances motor function and mobility
in patients with stroke, spinal cord injury, and other conditions.
Virtual reality: Provides immersive and interactive environments
for rehabilitation, improving cognitive and motor skills.

Non-invasive brain stimulation: Techniques like transcranial

magnetic stimulation (TMS) and transcranial direct current
stimulation (tDCS) promote neural plasticity and recovery.

Personalized medicine is another area of advancement in which

neurorehabilitation involves tailoring treatment approaches to an
individual's unique needs, goals, and circumstances. This approach
acknowledges that each person's brain, body, and experiences are
distinct, and that a one-size-fits-all approach may not be effective.
Applications of Personalized Medicine in Neurorehabilitation:

1. Stroke Rehabilitation: Tailoring rehabilitation programs to the

individual's specific cognitive and motor deficits.
2. Traumatic Brain Injury (TBI) Rehabilitation: Developing
personalized treatment plans to address the unique cognitive,
emotional, and behavioral challenges associated with TBI.
3. Spinal Cord Injury (SCI) Rehabilitation: Creating customized
rehabilitation programs to optimize functional recovery and
independence.
4. Neurodegenerative Disease Management: Personalizing
treatment approaches for individuals with Alzheimer's
disease, Parkinson's disease, and other neurodegenerative
disorders.
 Conclusion
• In conclusion, the nervous system is a complex and dynamic
entity that plays a crucial role in our overall health and well-
being. Recent advancements in neurorehabilitation have
significantly improved our understanding of the nervous
system and its response to injury and disease. By leveraging
technological innovations, personalized medicine, and
interdisciplinary collaboration, we can continue to develop
more effective treatments and improve the lives of
individuals with neurological disorders.
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