Basic neurotransmitters and neuromodulators

Neurotransmitters activate their receptors which influence ion channels that directly affect excitation or inhibition of the postsynaptic cell. These mechanisms operate within milliseconds.

Neuromodulators activate their receptors which bring about changes in metabolic processes in neurons, often via G protein coupled to second-messenger systems. Such changes, which can occur over minutes, hours, or even days, include alterations in enzyme activity or, through influences on DNA transcription, in protein synthesis.

Thus, neurotransmitters are involved in rapid communication, whereas neuromodulators tend to be associated with slower events such as learning, development, motivational states, and some types of sensory or motor activities.

Classes of some chemicals known or presumed to be neurotransmitters or neuromodulators:

1. Acetylcholine (ACh)

2. Biogenic amines

• Catecholamines
• Dopamine
• Norepinephrine
• Epinephrine
• Serotonin
• Histamine

3. Amino acids

• Excitatory amino acids
• Inhibitorry amino acids

4. Neuropeptides

5. Gases

6. Purines

Spinal injuries and stem cells

Spinal typically crush rather than cut the tissue leaving the axons intact. In this case, a primary problem is self-destruction (apoptosis) of the nearby oligodendrocytes. When these cells die and their associated axons lose their myelin coat, the axons cannot transmit information effectively. Severed axons within the CNS may grow small new extensions, but no significant regeneration of the axon occurs across the damaged site, and there are no well-documented reports of significant return of function. Functional regeneration is prevented either by some basic difference of CNS neurons or some property of their environment, such as inhibitory factors associated with nearby glia.

Researchers are trying a variety of ways to provide en environment that will support axonal regeneration in the CNS. They are creating tubes to support regrowth of the severed axons, redirecting the axons to regions of the spinal cord that lack growth-inhibiting factors, preventing apoptosis of the oligodendrocytes so myelin can be maintained, and supplying neurotrophic factors that support recovery of the damaged tissue.

Medical researchers are also attempting to restore function to damaged or diseased brains by implanting progenitor stem cells that will develop into new neurons and replace missing neurotransmitters or neurotrophic factors. Alternatively, pieces of fetal brain or tissues from the patient that produce the needed neurotransmitters or growth factors have been implanted. For example, in patients with Parkinson disease, a degenerative nervous system disease resulting in progressive loss of movement, the implantation of tissue from posterior portions of a fetal brain into affected area has been somewhat successful in restoring motor function. Ethical concerns have rendered the future of this technique uncertain, however.

(Widmaier EP, Raff H, Strang KT. Vander's Human Physiology: the mechanisms of body function. 12 ed.New York: McGraw-Hill International Edition; 2011)

What causes our heart to beat

I was very interested in realizng what actually causes our heart to continously beat from the time we are in our mother's body till we die.

So, I created this presentation for me to understand it better and I thought it would be interesting to share it with you.

The file is here

Synapses

 

A synapse is an anatomically specialized junction between two neurons, at which the electrical activity in a presynaptic neuron influences the electrical activity of a postsynaptic neuron. Anatomically, synapses include parts of the presynaptic and postsynaptic neurons and the extracellular space between them. According to the latest estimate, there are approximately 100 trillion! synapses in our CNS.

Activity at synapses can increase or decrease the likelihood that the postsynaptic neuron will fire action potentials by producing a brief, graded potential in the postsynaptic membrane. The membrane potential of a postsynaptic neuron is brought closer to threshold (i.e., depolarized) at an excitatory synapse, and it is either driven farther from threshold (i.e., hyperpolarized) or stabilized at its resting potential at an inhibitory synapse.

Hundreds or thousands of synapses from many different presynaptic cells can affect a single postsynaptic cell (convergence), and a single presynaptic cell can send branches to affect many other postsynaptic cells (divergence).

Action potential can travel both ways on a neuron, but they are transferred to adjacent neurons only though the synapses, from axon terminal to the postsynaptic membrane.

There are two types of synapses: electrical and chemical. At electrical synapses, the plasma membranes of the pre- and post- synaptic cells are joined by gap junctions,allowing the local current from arriving action potential to flow directly across the junction at places where communication in extremely rapid. At chemical synapses, the axon of the presynaptic neuron ends in a slight swelling, the axon terminal, which holds synaptic vesicles that contain neurotransmitters. The postsynaptic membrane adjacent to the axon terminal has a high density of intrinsic and extrinsic membrane proteins and receptors that make up the postsynaptic density. A 10 to 20 nm extracellular synaptic cleft seperates the pre- and the post- synaptic neurons.

(Widmaier EP, Raff H, Strang KT. Vander's Human Physiology: the mechanisms of body function. 12 ed.New York: McGraw-Hill International Edition; 2011)

Factors that determine synaptic strength

Factors that determine synaptic strength

A. Presynaptic factors

1. Availability of neurotransmitter
• Availability of precursor molecules
• Amount (or activity) of the rate-limiting enzyme in the pathway for neurotransmitter synthesis
2. Axon terminal membrane potential
3. Axon terminal Ca2+
4. Activation of membrane receptors in presynaptic terminal
• Axo-axonic synapses
• Autoreceptors
• Other receptors
5. Certain drugs and diseases, which act via the above mechanisms

B. Postsynaptic factors

1. Immediate past history of electrical state of postsynaptic membrane (e.g. excitation or inhibition from temporal or spatial summation)
2. Effects of other neurotransmitters or neuromodulators acting on postsynaptic neuron
3. Up- or down-regulation and desensitization of receptors
4. Certain drugs and diseases

C. General factors

• Area of synaptic contact
• Enzymatic destruction of neurotransmitter
• Geometry of diffusion path
• Neurotransmitter re-uptake

Drugs that bind to a receptor and produce a response similar to the normal activation of that receptor are called agonists. Drugs that bind to the receptor but are unable to activate it and block it are called antagonists.

Reference: Widmaier EP, Raff H, Strang KT. Vander's Human Physiology: the mechanisms of body function. 12 ed.New York: McGraw-Hill International Edition; 2011.

Body fluids and tissues

A very useful file I have created on this very basic but useful information for anyone that wants to get any kind of medical education. You will come across this terminology again and again and again and it is important to store it in your mind and understand the classification very well.

This is the file.

Walking with crutches

Precautions:

• Beware of slick or wet surfaces and throw rugs.
• Keep crutches near you so they are always within reach.
• Wear low heeled shoes that will not slip off (sneakers).
• Ask teachers in school to let child out of class a little
• early to avoid crowds on stairs and organize a
• buddy system.
• Keep the injured leg up on a stool when appropriate.
• Carry books and school supplies in a backpack to leave both hands free.

(this video was suggested to me by my classmate Bita Lotfaliei)

Posterior Spinal Fusion L1 Burst Fracture

General characteristics of this trauma:

Primary complaints: low back pain that worsens with movement.

Usually present with kyphotic posture that is unlikely to be corrected, hip flexor contractures, and moderate pain at the level of the fracture.

If the fracture has compressed the spinal nerve root, then the patient could have radiating symptons such as numbness and tingling,

The patient could have cauda equina symptons with complaints of numbness, tingling, weakness, or problems with bowel and bladder.

Acceptance & Commitment Therapy (ACT)

source: the Association for Contextual Behavioral Science (ACBS)

Psychological Inflexibility: An ACT View of Suffering

The core conception of ACT is that psychological suffering is usually caused by the interface between human language and cognition, and the control of human behavior by direct experience. Psychological inflexibility is argued to emerge from experiential avoidance, cognitive entanglement, attachment of a conceptualized self, loss of contact with the present, and the resulting failure to take needed behavioral steps in accord with core values. Buttressed by an extensive basic research program on a associated theory of language and cognition, Relational Frame Theory (RFT), ACT takes the view that trying to change difficult thoughts and feelings as a means of coping can be counter productive, but new, powerful alternatives are available, including acceptance, mindfulness, cognitive diffusion, values, and committed action.

The ACT Model

ACT is an orientation to psychotherapy that is based on functional contextualism as a philosophy and RFT as a theory. As such, it is not a specific set of techniques. ACT protocols target the processes of language that are hypothesized to be involved in psychopathology and its amelioration, such as:

• cognitive fusion -- the domination of stimulus functions based on literal language even when that process is harmful,
• experiential avoidance -- the phenomenon that occurs when a person is unwilling to remain in contact with particular private experiences and takes steps to alter the form or frequency of these events and the contexts that occasion them, even when doing so causes psychological harm
• the domination of a conceptualized self over the "self as context" that emerges from perspective taking and deictic relational frames
• lack of values, confusion of goals with values, and other values problems that can underly the failure to build broad and flexible repertoires
• inability to build larger unit of behavior through commitment to behavior that moves in the direction of chosen values

and other such processes. Technologically, ACT uses both traditional behavior therapy techniques (defined broadly to include everything from cognitive therapy to behavior analysis), as well as others that are more recent or that have largely emerged from outside the behavior tradition, such as cognitive defusion, acceptance, mindfulness, values, and commitment methods.

ACT for Physical Therapists

ACT can be very useful for patients suffering from chronic pain. For many of these patients the persisting pain starts to interfere with life. Most often the response to this situation is that patients stop doing the things they want to do at work and in their private life. For many of these patients avoiding pain and struggling with it becomes the focus of their life.

In challenging the patients to notice the pain and notice all the things the mind tells you about it (whether they are true or not).

This training in noticing of awareness is a mindfulness therapy. ACT does not aim to eliminate pain but tries to turn the focus back to what the patients want their lives to be about.

Pain is not the same as pain behavior  Pain behavior is what we do in response to pain and pain behavior is subject to all the usual influences on behavior and can be reinforced just like other behaviors.

GetBodySmart.com

A very nice and simple website about human anatomy and physiology, with photos, flashcards,  and quizzes useful to every student.

GetBodySmart.com

:: Mission Statement ::

My name is Scott Sheffield, and I am the sole owner and developer of this site. Thank you for visiting!

GetBodySmart represents my attempt to create a fully animated and interactive eBook about human anatomy and physiology. The contents and design of this long-term project are based on my 21 years of teaching this material at the university level.

While it is being constructed, I invite all interested teachers, students, healthcare professions, and others to use the free tutorials and quizzes in GetBodySmart to help explain the body's complex physiological interactions and illustrate its important anatomical landmarks.

The site is in the very early stages of development, and a lot of content is still missing. Please be patient. Even though my pace is somewhat slow, I try to make additions/updates every day.

Because this is a large and complicated project, it will realistically take me many years to develop GetBodySmart into a truly comprehensive learning resource.

Understanding Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is one of the most common disorders a Physical Therapist has to deal with, especially the last years.

This video presents in a very easy to understand way this disorder.

You can find the Royal Dutch Society for Physiotherapy's (KNGF) treatment guidelines for COPD here.

Subcapital humerus fracture

This video presents the 3.5 mm LCP Periarticular Proximal Humerus Plate for subcapital humerus fractures. The 3.5 mm LCP Periarticular Proximal Humerus Plate features a posterior sweep in the head to buttress the greater tubercle.

Features and Benefits

Plates anatomically designed for left and right humerus

Plate sits distal to the rotator cuff to reduce impingement

Plate sits slightly anterior to reduce deltoid impingement

Suture holes with undercuts aid in reduction and ligament reattachment

Plate features 8 holes in the head

2 holes directed into the calcar act as a medial buttress

Limited-contact underside minimizes plate-to-bone contact

Tapered tip aids in percutaneous insertion

Indications

Synthes 3.5 mm Periarticular Proximal Humerus Plates are indicated for fractures, fracture dislocations, osteotomies, and nonunions of the proximal humerus, particularly in osteopenic bone.

Please refer to the package insert for a complete list of indications, contraindications, precautions and warnings.

Treatment protocol

First 3 weeks postoperatively the patient wears a shoulder vest. This vest may not be used during physiotherapy and showering.

Abduction and flexion to 30 degrees allowed (guided active).

After 3 weeks tapering shoulder vest and extend mobility to a maximum of 90 degrees.

After 6 weeks increase mobility by pain and function, and increase functional use.

Note:
First 6 weeks postoperatively no external rotation
First 3 months postoperatively no resistance training

Motor control and the ITE model

Motor control is defined as the ability to regulate or direct the mechanisms essential to movement (Motor Control, Anne Shumway-Cook, Marjorie H. Woolacott, Wolters Kluwer, International Edition).

Understanding the nature of movement is one of the most crucial lessons for a Physical Therapy student and this specific book is a masterpiece every student should have.

During my studies in the European School of Physiotherapy at the Hogeschool van Amsterdam, I created this small presentation of the ITE model based on the 1st chapter of the Motor Control book.

The ITE model is a conceptual model that suggests that movement of the individual is organized around him, the task he has to accomplish and the environment. Although it seems to be obvious, it takes a lot of deep undesrtanding of this model in order to really understand how movement is created in the body and then be able to deal with it as a Physical Therapist.

University of Alberta, Faculty of Rehab Medicine

The University of Alberta has developed a separate Faculty of Rehabilitation Medicine for the following departments:

Department of Occupational Therapy

Department of Physical Therapy

Department of Speech Pathology & Audiology

Rehabilitation Science Degrees - MSc, PhD

Institute for Stuttering Treatment and Research (ISTAR)

They promote the following in their very professional and full of useful context website:

"UAlberta is considered among the world’s leading public research- and teaching-intensive universities. As one of Canada’s top universities, we’re known for excellence across the humanities, sciences, creative arts, business, engineering, and health sciences".

Very interesting is also the Glen Sather Clinic they have developed.

Watch also this one:

Content Guidelines for Canadian University Programs

If you are interested in studying Physical Therapy or working as a PT in Canada, a country where Physical Therapy is very well developed, then you should definitely have a look at the website of the Canadian Council of University Programs.

Very useful documents to look through are the following:

National Physiotherapy Curriculum Guidelines

National Physiotherapy Clinical Education Guidelines

Essential Competency Profile for Physiotherapists in Canada

From their website:

"Physiotherapy is a dynamic health care profession with foundations in theory and research and specialized clinical expertise. Each of the 14 Canadian Universities offering physiotherapy education provide a professional, entry-level program and as of 2012 all will be at the Master's level. Within each of these programs, the curriculum is presented in a course-based Master's format. Ten programs are offered in English and 4 in French. Physiotherapy is a regulated profession meaning an active license or practice permit, from the provincial regulatory organization, is required. Successful completion of an accredited entry-level program allows the graduate to sit the national Physiotherapy Competency Examination (PCE). For most provinces, successful completion of the PCE is required for registration. Clinical Master's and/or thesis-based Master's and Doctorate programs are offered by most of the 14 Universities with entry-level programs. These are typically designed for physiotherapy and other healthcare clinicians wanting to pursue further academic education and generally follow a more traditional graduate education format. Physiotherapy specific and interdisciplinary post-graduate certifications and advanced practice courses are also available at many universities".

Google tips & tricks for students

A beautiful and very useful link with tips & tricks for students conducting online research. Of course, Google is not the only source we, as students, should use, but it is always a starting point when trying to do a research.

(this link is suggested to us by my classmate Nicholas Paul).

The history of physical therapy

A very nice and short YouTube series of 4 videos on the 1st WCPT Congress (London, 1953).

Besides, I believe every Physical Therapy student should have a quick at the Wikipedia's article on the history of Physical Therapy:

Physicians like Hippocrates and later Galenus are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 BC. After the development of orthopedics in the eighteenth century, machines like the Gymnasticon were developed to treat gout and similar diseases by systematic exercise of the joints, similar to later developments in physical therapy.

The earliest documented origins of actual physical therapy as a professional group date back to Per Henrik Ling, “Father of Swedish Gymnastics,” who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise. The Swedish word for physical therapist is sjukgymnast = someone involved in gymnastics for those who are ill. In 1887, PTs were given official registration by Sweden’s National Board of Health and Welfare.

Other countries soon followed. In 1894 four nurses in Great Britain formed the Chartered Society of Physiotherapy. The School of Physiotherapy at the University of Otago in New Zealand in 1913, and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides".

What is also very interesting is to have a look at the history of the oldest Society of Physiotherapists in the world, the British Chartered Society of Physiotherapy.

Common postural diviations

Maximal range of motion across the different vertebrae regions

A very nice graph summarizing the overall maximal range of motion (in degrees) allowed across three planes, throughout the cervical, thoracic, and lumbar regions.

You can see it here.

source: Kinesiology of the musculoskeletal system, Donald A. Neumann, 2nd edition, Mosby Elsevier

Nerves lesions and compression syndromes

It is very important for a PT student to be be able to follow the course of the major peripheral nerves of the upper and lower extremities in order to be able to recognize and assess possible impingement regions.

I have created a short list with the major peripheral nerves lesions and compression syndromes for that reason.

You can find it here.

European Network of Physiotherapy in Higher Education

WHAT IS ENPHE?

The aim of the European Network of Physiotherapy in Higher Education is to bring together and enhance collaboration between European Institutes and physiotherapy educational institutions in the European region in order to:

1. provide a forum for interaction and exchange of educational developments;
2. promote the convergence of physiotherapy educational programmes;
3. stimulate the development of a European dimension in physiotherapy educational curricula;
4. facilitate mobility of staff and students between physiotherapy educational institutions;
5. encourage and support standards of high quality education in physiotherapy in accordance with the recommendations of the World Confederation for Physical Therapy (WCPT);
6. advance the body of knowledge of physiotherapy;
7. facilitate collaborative research projects between physiotherapy educational institutions;
8. establish and maintain contacts and exchange information with other national and international bodies, organisations, and with the European authorities.

source: the European Network of Physiotherapy

Spinal Stenosis Surgery: The X-STOP

The X-STOP is a minimally invasive surgical procedure designed to alleviate painful symptoms of lumbar spinal stenosis. The device is inserted into the back of the spine to prevent a patient from bending too far backward at the narrowed segment, a position that for patients with spinal stenosis can cause leg pain (sciatica) and/or lower back pain.

source: www.spine-health.com

Useful information on postoperative care after X-STOP surgery here.

Spine health: trusted information for back pain and neck pain relief

Our goal is to provide you with a comprehensive, highly informative and useful resource for understanding, preventing, and seeking appropriate treatment for back and neck pain and related conditions.

This site has been developed by a multi-specialty group of medical professionals. It will be continually enhanced with new features, and we will base its direction and future developments primarily on your feedback (please see contact us) to send in your suggestions.

What is unique about Spine-health.com?

Who are the people behind Spine-health.com?

What is the purpose of the site?

What is the quality of the content?

What is the business model?

source: spine-health