05b Sensory Function

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  • Neurophysiology Series SENSORY FUNCTIONOF THE NERVOUS SYSTEMwww.physiology.sdu.edu.cn By Sawiji AmaniMobile phone: 081 328 028333E-mail: sawijiamani@gmail.com

    Basic Sciences DepartmentMuhammadiyah Gombong UniversityCentral Java Indonesia

  • I Sensory pathwaysSensory systems allow us to detect, analyze and respond to our environmentascending pathwaysCarry information from sensory receptors to the brainConscious: reach cerebral cortexUnconscious: do not reach cerebral cortexSensations from body reach the opposite side of the brain

  • 1. Sensory receptorsA: Free nerve endings (pain, temperature)

    B: Pacinian corpuscle (pressure)

    C: Meissners corpuscle (touch)

    D: Muscle spindle (stretch)

  • Sensory receptors

  • Ruffini's endings respond to tension and stretch in the skin

  • Sensory receptors

    Sensory receptors: organs which detect sensory stimuli .

    Sensory stimuli: sensation modality (touch, sound, light, pain, cold, and warmth..etc)

  • Sensory receptors

    Mechanoreceptors: detect mechanical compression or stretching of tissues Thermoreceptors: detect changes in temperature Nociceptors (pain receptors): detect tissue damage ( physical or chemical damage) Chemoreceptors: detect taste in the mouth, smell in the nose, oxygen level ..etc.Electromagnetic receptors (photoreceptor): detect light on the retina

  • 2. Sensory pathways: 3 neurons1st: enters spinal cord from periphery2nd: crosses over (decussates), ascends in spinal cord to thalamus3rd: projects to somatosensory cortex

  • 2.1 Spinothalamic pathwayCarries pain, temperature, touch and pressure signals1st neuron enters spinal cord through dorsal root2nd neuron crosses over in spinal cord; ascends to thalamus3rd neuron projects from thalamus to somatosensory cortex

  • Spinothalamic PathwaySmall sensory fibres:Pain, temperature, some touchPrimary somatosensory cortex (S1)ThalamusMedullaSpinal cordSpinothalamic tract

  • Spinothalamic damage

  • 2.2 Dorsal column pathwayCarries fine touch, vibration and conscious proprioception signals1st neuron enters spinal cord through dorsal root; ascends to medulla (brain stem)2nd neuron crosses over in medulla; ascends to thalamus3rd neuron projects to somatosensory cortex

  • Two-Point Discrimination

  • Dorsal column pathwayLarge sensory nerves:Touch, vibration, two-point discrimination, proprioceptionPrimary somatosensory cortex (S1) in parietal lobeThalamus MedullaMediallemniscusSpinal cordDorsal columnDorsal columnnuclei

  • Dorsal column damage

  • Dorsal column damage

    Sensory ataxia

    Patient staggers; cannot perceive position or movement of legs

    Visual clues help movement

  • Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved. ataxia[ah-takse-ah] failure of muscular coordination; irregularity of muscular action. adj., adj atactic, ataxic.sensory ataxia: ataxia due to loss of proprioception (joint position sense), resulting in poorly judged movements and becoming aggravated when the eyes are closed.

  • Central Pathways

  • Sensory pathways cross the bodys midline (Silverthorn: 2007)

  • 3.3 Spinocerebellar pathwayCarries unconscious proprioception signalsReceptors in muscles & joints1st neuron: enters spinal cord through dorsal root2nd neuron: ascends to cerebellumNo 3rd neuron to cortex, hence unconscious

  • Spinocerebellar tract damageCerebellar ataxia : ataxia due to disease of the cerebellum. Clumsy movementsIncoordination of the limbs (intention tremor)Wide-based, reeling gait (ataxia)Alcoholic intoxication produces similar effects!

  • 4. Somatosensory cortex Located in the postcentral gyrus of the human cerebral cortex.

  • Lobus Parietalis: Fungsi & Asosiasi Somatosensoris Gyrus postsentral : korteks somatosensori primer Sentuhan/raba lembut, tekanan, nyeri & suhu, sensasi umum di kepala Sensory homunculus (representasi disproporsional)

  • Spatial orientation of signals.Each side of the cortex receives sensory information exclusively from the opposite side of the body (the exception: the same side of the face).

  • Spatial orientation of signals.2)The lips, face and thumb are represented by large areas in the somatic cortex, whereas the trunk and lower part of the body, relatively small area.3)The head in the most lateral portion, and the lower body is presented medially

  • Sensory homunculus (representasi disproporsional)

  • Sensory homunculus (representasi disproporsional)

  • II . Pain

  • Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

    International Association for the Study of Pain

  • Why feel pain?Gives conscious awareness of tissue damageProtection:Remove body from dangerPromote healing by preventing further damageAvoid noxious stimuliElicits behavioural and emotional responses

  • free nerve endings in skin respond to noxious stimuli

    1. Nociceptors

  • NociceptorsNociceptors are special receptors that respond only to noxious stimuli and generate nerve impulses which the brain interprets as "pain".

  • Adequate StimulationTemperatureMechanical damageChemicals (released from damaged tissue) Bradykinin, serotonin, histamine, K+, acids, acetylcholine, and proteolytic enzymes can excite the chemical type of pain. Prostaglandins and substance P enhance the sensitivity of pain endings but do not directly excite them.Nociopectors

  • Hyperalgesia: The skin, joints, or muscles that have already been damaged are unusually sensitive. A light touch to a damaged area may elicit excruciating pain;

    Primary hyperalgesia occurs within the area of damaged tissue; Secondary hyperalgesia occurs within the tissues surrounding a damaged area.

  • 2. Localization of PainSuperficial Somatic Pain arises from skin areasDeep Somatic Pain arises from muscle, joints, tendons & fasciaVisceral Pain arises from receptors in visceral organslocalized damage (cutting) intestines causes no paindiffuse visceral stimulation can be severedistension of a bile duct from a gallstonedistension of the ureter from a kidney stone

  • Most pain sensation is a combination of the two types of message. If you prick your finger you first feel a sharp pain which is conducted by the A fibres, and this is followed by a dull pain conveyed along C fibres.

    3. Fast and Slow Pain

  • Fast pain (acute)occurs rapidly after stimuli (.1 second)sharp pain like needle puncture or cutnot felt in deeper tissueslarger A nerve fibersSlow pain (chronic)begins more slowly & increases in intensityin both superficial and deeper tissuessmaller C nerve fibers

  • Impulses transmitted to spinal cord byMyelinated A nerves: fast pain (80 m/s)Unmyelinated C nerves: slow pain (0.4 m/s)

  • Impulses ascend to somatosensory cortex via:Spinothalamic pathway (fast pain)Reticular formation (slow pain)

  • 4. Visceral painNotable features of visceral pain:Often accompanied by strong autonomic and/or somatic reflexesPoorly localized; may be referred referred painMostly caused by distension of hollow organs or ischemia (localized mechanical trauma may be painless)

  • Afferent innervation of the viscera.Often anatomical separation nociceptive innervation (in sympathetic nerves) from non-nociceptive (predominantly in vagus). Many visceral afferents are specialized nociceptors, as in other tissues small (Ad and C) fibers involved. Large numbers of silent/sleeping nociceptors, awakened by inflammation. Nociceptor sensitization well developed in all visceral nociceptors.

  • Referred painPain originating from organs perceived as coming from skin

    Site of pain may be distant from organ

  • Convergence theory: This type of referred pain occurs because both visceral and somatic afferents often converge on the same interneurons in the pain pathways.

    Excitation of the somatic afferent fibers is the more usual source of afferent discharge,

    so we refer the location of visceral receptor activation to the somatic source even though in the case of visceral pain.

    The perception is incorrect.The convergence of nociceptor input from the viscera and the skin.Referred pain

  • 5. Pain Gate TheoryMelzack & Wall (1965)

    A gate, where pain impulses can be gated

    The synaptic junctions between the peripheral nociceptor fiber and the dorsal horn cells in the spinal cord are the sites of considerable plasticity.

    A gate can stop pain signals arriving at the spinal cord from being passed to the brain

    Reduced pain sensationNatural pain relief (analgesia)

  • How does pain gate work?The gate = spinal cord interneurons that release opioids.

    The gate can be activated by:

    Simultaneous activity in other sensory (touch) neuronsDescending nerve fibers from brain

  • Applications of pain gateStimulation of touch fibres for pain relief:TENS (transcutaneous electrical nerve stimulation)AcupunctureMassage

    Release of natural opioidsHypnosisNatural childbirth techniques

  • 6. Pain ReliefAspirin and ibuprofen block formation of prostaglandins that stimulate nociceptorsNovocain blocks conduction of nerve impulses along pain fibersMorphine lessen the perception of pain in the brain.

  • Phantom Limb Sensation(Tortora & Derrickson, 2006:552)Patients who have had a limb amputated may still ex