Module III

AKHIL KUMAR S
ASSISTANT
PROFESSOR
MLMCE
 Human Nervous System
Control and communication network
Responsible for sending, receiving, and interpreting
information from all parts of the body.
Monitors and co-ordinates internal organ function and
responds to changes in the external environment.
Includes:
Brain
Spinal cord
Network of neurons.
Divided into :
Central nervous system(CNS)
Peripheral nervous system(PNS)
 Central nervous system (CNS)
Processing center for the nervous system
Receives information from and sends information to the
peripheral nervous system.
Two main organs of the CNS:
Brain
Spinal cord.
 Brain
Brain is the center of all activities
Memory
Computational Power
Decision making capability
Hosts input and output channels
The brain processes and interprets sensory information sent
from the spinal cord.
Brain and spinal cord are protected by a three-layered covering
of connective tissue called the meninges.
Cerebrum:
Largest part of the brain
Composed of right and left hemispheres
Performs higher functions like interpreting touch, vision and
hearing, reasoning, emotions, learning, and fine control of
movement.
Cerebellum:
Located under cerebrum
Coordinate muscle movements, maintain posture, and balance
Brainstem:
Acts as a relay center connecting the cerebrum and
cerebellum to the spinal cord
Performs many automatic functions such as breathing, heart
rate, body temperature, wake and sleep cycles, digestion,
sneezing, coughing, vomiting, and swallowing.
 Spinal cord
Connects the brain to nerves throughout the body
Pathway for impulses from the body to the brain, and from
the brain to the body
Controls simple musculoskeletal reflexes without input from
the brain
Cylinder of nerve tissue
 38 to 45cm
Peripheral nervous system (PNS)
Nerves and group of neurons outside brain and spinal
cord
Connect the CNS to the organs, limbs and skin.
The nerves that make up the PNS is axons or bundles of
axons from neuron cells.
 1. Somatic nervous system
Carry sensory and motor information to and from the
CNS.
Contains two major types of neurons:
1. Sensory neurons (or afferent neurons): Carry information
from the nerves to the CNS
2. Motor neurons (or efferent neurons): Carry information
from the brain and spinal cord to muscle fibers throughout
the body.
 2. Autonomic Nervous systems
Regulate involuntary (reflex/Unintentional)body functions
include blood flow, heartbeat, digestion and breathing.
Two branches:
Sympathetic system
Parasympathetic system
Sympathetic system: Regulates the flight-or-fight responses.
fight or flight response means our body's primitive, automatic,
inborn response that prepares the body to "fight" or "flee" from
perceived attack, harm or threat to our survival.
Parasympathetic system: helps to maintain normal body
functions and conserves physical resources
 Neuron
Basic functional unit of NS
Cells within the NS that transmit information to other nerve
cells, muscle, or gland cells.
Nucleated cell body
Branches
1. Axon: Conduct impulses towards the cell body
2. Dendrite: Conduct impulses away from the the cell
body
There are about 86 billion neurons in the human brain
Comprises roughly 10% of all brain cells.
Neurons are connected to one another and tissues.
They do not touch and instead form tiny gaps
called synapses
The signal passes between the neurons via synapses
Impulses are transmitted from one neuron to other via
synapses
Action potential mechanism is utilized from the axon of the
neuron across synapse to dendrite of another neuron
Types:
Sensory neurons: carry signals from sense organs to the
spinal cord and brain.
Motor neurons: carry signals from the CNS to muscles
Unlike other body cells, neurons stop reproducing shortly
after birth.
Some parts of the brain have more neurons at birth than later in
life because neurons die but are not replaced.
Axon and dendrites transmit and receive information.
Neurons release chemicals known as neurotransmitters into
the synapses to communicate with other neurons
 Action potential of brain
Neurons need to transmit information within the neuron
and from one neuron to the next.
This utilizes both electrical signals as well as chemical
messengers
When a neuron is not sending signals
 inside has -ve charge relative to the positive charge
outside the cell.
At rest, cell membrane
allows certain ions to pass through
restrict the movement of other ions.
The resting potential of the neuron is the difference
between the voltage inside and outside the neuron.
Around -70 mv
When an impulse is sent out from a cell body, the
sodium cells rush into the cell.
Once the cell reaches a certain threshold an action
potential will be generated and sends the electrical
signal down the axon.
After excitation, there is a refractory period in which
another action potential is not possible.
Sodium ions get out of the cell(Sodium pump),
gradually returning the neuron to its resting potential.
Dendrites receive information from sensory receptors or other
neurons
This information is then passed down to the cell body and on
to the axon.
Once the information as arrived at the axon, it travels
down the length of the axon in the form of an electrical
signal known as an action potential
Action potential is part of the process that occurs during
the excitation of a neuron
 Communication between neurons
Communication between neurons is achieved at synapses by
the process of neurotransmission
Action potential is generated near the cell body portion of the
axon
This is then propagated along the axon until it reaches its axon
terminals
Information is transmitted across the synaptic gap to the
dendrites of the adjoining neuron.
At the junction between two neurons (synapse), an action
potential causes a neuron to release a chemical
neurotransmitter.
 Neurotransmitters
Neurotransmitters are the chemical messengers that are
released from the axon terminals to cross the synaptic gap
and reach the receptor sites of other neurons
The neurotransmitter excites the adjacent neuron from firing
its own action potential.
Essential part of our everyday functioning
Acetylcholine:
Associated with memory
Muscle contractions
Learning
A lack of acetylcholine in the brain is associated with
Alzheimer’s disease
Endorphins:
Associated with emotions and pain perception.
Body releases endorphins in response to fear or trauma.
Similar to drugs such as morphine, but are significantly
stronger
Dopamine:
Associated with thought and pleasurable feelings.
Parkinson’s disease is one illness associated with deficits in
dopamine
Schizophrenia is strongly linked to excessive amounts of
this chemical messenger
 Brain waves
Brain waves are the wave patterns that can be observed in an
EEG
Delta Waves
Frequency of 0.5-4 Hz
Amplitude of 20- 200µV
During deep sleep
Very irregular and slow wave patterns
Useful in detecting tumors and abnormal brain behaviors.
Theta waves:
Frequency of 4-7Hz
Amplitude: 20- 100µV.
These waves are believed to be more common in children
than adults.
Alpha Waves:
Frequency of 8-13 Hz
Amplitude of 20- 60 µV.
Produced when quietly sitting in relaxed position with
eyes closed or drowsy
Beta waves:
Characteristic frequency of 14-30 Hz
Amplitude of 2-20 µV.
Paradoxical sleep
Rapid eye movement(REM)
Gamma Waves:
Frequency of 36-44Hz
Amplitude of 3- 5µV
Occur with sudden sensory stimuli
 EEG-Electroencephalography
Recording of the brain's spontaneous electrical activity
over a short period of time
Multiple electrodes placed on different positions on the scalp
For diagnosing neurological illness and diseases
Epilepsy
Tumor
Cerebrovascular lesions(A lesion is an area of tissue that has
been damaged through injury or disease)
Ischemia
Problems associated with trauma
Before CT scans and MRI, the first-line diagnosis for tumours
and other brain disorders
Non-invasive technique
Indicates the active brain area but cannot precisely indicate
where the signal came from
Record electrical activities from the cortical surface close to
the skull
Age-dependent
Younger the child slower the activities
Elderly people have slower pattern
With the increase in age the EEG pattern becomes slower
 EEG analysis
Frequency and amplitude is crucial
Computerised EEG signal processing

Frequency analysis:
FFT
Break into component frequencies
EEG  Spectrum
Then divided into frequency bands at intervals 0.5Hz over a
range of 1 to 32Hz.
Converts time domain signal to frequency domain

Amplitude analysis:
Power spectrum is calculated
As amplitude increases so does the power
Powers of individual bands of frequency expressed as a %
of total power
 Electrodes
Essentially Five types of electrodes are used
Scalp electrodes are in the shape of silver pads discs or cups
made of stainless steel and chloride silver wires.
Spheroidal electrodes are alternating insulated silver and
bare wire and chloride tip inserted through muscle tissue by a
needle
Nasopharyngeal electrodes are silver rod with silver ball at
the tip inserted through the nostrils
Electrocorticographic electrodes are cotton wicks soaked in
saline solution that rests on the brain surface.
Intracerebral electrodes are Teflon coated gold or platinum
wires used to stimulate the brain.
Montage:
Pattern of electrodes on the head and the channel they are
connected to is called montage
Always symmetrical
Reference electrode is placed on a non active site
ie forehead or ear lobe
Electrodes arranged on the scalp according to the standard
10/20 system
21 electrode location in 10/20 system
10% and 20% is the actual distance between the adjacent
electrodes
Bipolar:
Made by subtraction of signals from adjacent electrode
pairs
Referential:
Made by subtracting of potential of a common reference
electrode from each electrode on the head
Each montage displays different spatial characteristics of the
same data
F  Frontal

Fp  Frontal-Polar

C  Central

P  Parietal

T  Temporal

O  Occipital

Odd numbers  on the left side

Even numbers  on the right side

Z  Midline electrodes
Electrodes are identified according to position on the
head
 Placement/Arrangement of Electrodes
Electrodes are placed in standard positions on the skull in an
arrangement 20 system.
Draw a line on the skull from the nasion to the inion.
Draw a similar line from the left preauricular (ear) point to
the right preauricular point.
Mark the intersection of these two lines as Cz, which is the
mid point of the distance between the nasion and inion (or)
the distance between the auricular points.
Mark points at 10,20,20,20 and 10% of the total nasion
inion distance. These points are Fpz,Fz,Cz,Pz,and Oz.
Mark points at 10,20,20,20,20 and 10% of the total distance
between the preauricular points.
These points are T3,C3,Cz,C4 and T4. In these odd
numbered points T3 and C3 are on the left and even
numbered points C4 and T4 are on the right.
Measure the distance between Fpz and Oz, along the great
circle passing through T3 and mark points at 10,20,20,20,20
and 10% of this distance. These are the positions of
Fp1,F7,T3,T5 and O1.
Repeat this procedure on the right side and mark the
positions of Fp2,F8,T4,T6 and O2.
Measure the distance between Fp1 and O1, along the great
circle passing through C3 and mark points at 25% intervals.
These points give the positions of F3, C3 and P3
 The ground reference electrode is a metal clip on the
earlobe.
Repeat this procedure on the right side and mark the
positions of F4, C4 and P4
Check that F7,F3,Fz,F4 and F8 are equidistant along the
transverse circle passing through F7,Fz and F8 and check
that T5, P3,Pz,P4 and T6, are equidistant along the
transverse circle passing through T5, Pz and T6.
The positions of the scalp electrodes are indicated. Further
there are nasopharyngeal electrodes Pg1 and Pg2 and ear
electrodes A1 and A2.
Before placing the electrodes, the scalp is cleaned, lightly
abraded and electrode paste is applied between the electrode
and the skin.
Generally disc like surface electrodes are used.
In some cases, needle electrodes are inserted in the scalp to
pick up EEG.
Both bipolar and unipolar (monopolar) electrode systems
are used to facilitate the location of foci, that is cortical areas
from which abnormal waves spread.
The phase relationship of the waves indicates the position of
the focus and in some cases, it enables the velocity at which
the waves spread to be calculated.
In bipolar technique the difference in potential between two
adjacent electrodes is measured.
In the monopolar technique the potential of each electrode is
measured with respect to a reference electrode attached to ear
lobe or nostrils.
In the Wilson technique (or) average mode recording techniques
the potential is measured between one of the electrodes (exploring
electrode) and the central terminal which is formed by connecting
all electrodes through high equal resistors to a common point.
 Multichannel electroencephalographs having as many as the
channels permit simultaneous recording from several pairs of
electrodes reducing the total time required to complete the
recordings. Eight channel recorders are very popular.
Electrode montage selector:
EEG signals are transmitted from the electrodes to the head
box to montage selector.
Large panel containing switches.
Allow the user to select which electrode pair will have
signals subtracted from each other to create an array of
channels of o/p(montage)
Each channel in the form of the i/p from one electrode minus
i/p from the second electrode
Preamplifier
For each channel
Multistage
AC coupled
Sensitive
High gain in a wide range
Low noise
High CMRR
Differential amplifier
Must be free from drift
to prevent slow movement of recording pen from its
centre position as a result of change in temperature etc.
Calibration-50µv/cm
Sensitivity control
Overall sensitivity=Gain x sensitivity of writer
Filter bank:
Muscle artefacts cause difficulty in EEG interpretation-LPF
Notch filter eliminates mains frequency interference
Filter bank selects different types of brain waves
Noise:
Noise level is expressed in terms of an equivalent i/p voltage
2µv -Acceptable
Contains all frequencies
Increases with bandwidth
Noise level should be restricted for faithful reproduction of
signal
Writing part:
Ink type direct writing recorder
Pen motors-frequency response 90Hz
Inkjet-1000Hz
Paper drive:
Provided by synchronous motor
Speeds:15,30 & 60mm/sec
Time scale registered by time marker pens
Channels:
Array of electrodes
Commercial machines have 32 channels
8 and 16 are common
Modern ECG machines:
PC based
Pentium processor
16MB RAM
At least 2GB hard disk
Store up to 40 Hrs of EEG
 EVOKED POTENTIAL
If an external stimulus is applied to the sensory area of the
brain it responds by producing an electrical potential called
Evoked potential.
Evoked potentials are used to measure the electrical activity
in certain areas of the brain and spinal cord.
EEG are record of electrical voltages from the brain,
representing the averaged electrical activity of millions of
neurons
But evoked potentials are triggered.
They are very specific
EEG response to some form of stimulus, such as a flash of a
light or an audible click etc. is measured
Integrated response of the action of many cells
Amplitude-10µV
Superimposed with EEG
The evoked response always occurs at a set time after
stimulation
Background EEG and other unwanted signals
Random signal or irregular
Not time locked or synchronized with stimuli
Averages out to zero
Averaging technique gives only the evoked response
(a) raw EEG of single response

(b) average of 8 responses

(c) average of 64 responses.

Types:
Visual Evoked Potentials (VEP): the patient sits before a
screen in which alternating patterns are displayed.
Auditory Evoked Potentials (AEP): the patient listens to a
series of clicks in each ear.
Sensory Evoked Potentials (SEP): Short electrical
impulses are applied on the arm or leg.
Motor Evoked Potentials: Detects disruption on a motor
pathway of the brain or spinal cord.
 Electromyograph(EMG)
Record electrical activity of muscles
Combined effect of action potentials of muscle fibres.
For recording electrical activity of a muscle in response to
stimulation of its nerve
In response to nerve stimulation
Whether a muscle contracts or not (neuromuscular function)
Detect locations of muscle lesion
Reflex response
For myoelectric control of artificial limbs
Pick up EMG signals from the muscles at terminated nerve
endings of the remaining limb
Using this signal activate a mechanical arm
Nerve conduction velocity
The rate at which an action potential moves down a fibre or
propagated is the Nerve Conduction Velocity.
Measures how fast an electrical impulse moves through the
muscle fibres

 Stimulation usually with electrodes attached to your skin.

2 electrodes are placed on the skin.
One electrode stimulates with a very mild electrical
impulse.
The other electrode records it.
Electrical pulse of duration 0.2-0.5ms is applied through the
stimulating electrode.
When the excitation reaches the muscle, it contracts.
The action potential of the muscle is picked up by the EMG
electrode and is displayed on the oscilloscope along with the
stimulating pulse
Speed is calculated by
Measuring the distance between electrodes
Time taken by electrical impulses to travel between
electrodes
Normal- 50m/s
Below 40m/s-There is some disorder in that nerve
conduction.
Helps to find the presence, location, and extent of diseases that
damage the nerves and muscles
Block diagram for EMG recording
Recorded using
Surface electrodes
 Disposable
 Adhesive
 Oneswhich can be used repeatedly
Needle electrodes
Ground electrode/Reference electrode
Pick up potentials generated by contracting muscles
Electrodes used:
Amplifier:
Differential
High CMRR
Input impedance
Applied to A.F amplifier connected to Loud speaker
Tape recorder is used for playback and study of EMG sound
waves for a later time
Audio amplifier and loudspeaker
Allow the operator to hear the “crackling” sounds of the
EMG
Helps in the placement of needle or wire electrodes into a
muscle
Amplitude
Depends on placement of electrodes
Amount of muscle activity
0.1 to 0.5 mV
Frequency up to 10KHz
Oscilloscope is used instead of a graphic pen recorder
Modern machines - PC based
Stimulus software controlled
Built-in stimulator:
Measures nerve conduction velocity by stimulating a given
nerve location and measuring the EMG
 Respiratory system
Exchange of gases between the blood and external
environment - External respiration
Lungs
Supplies blood with oxygen
Removes CO2 waste produced by cells
Nasal cavities
Pharynx
Larynx
Trachea
Bronchi
Bronchioles
Lungs
Main organ of the respiratory system.
Elastic bags located in a closed cavity (Thorax/Thoracic
cavity)
Right lung:3 lobes
Left lung:2 lobes
Air enters the lungs through the air passages:
Nasal Cavity
Passes air through nose
Mouth
 Passes air through it

Pharynx:
The throat
Cone shaped passageway
leading to trachea.

Larynx:
Voice box(contains vocal cords)
Epiglottis:
Flap that covers the entrance to the trachea.
Closes whenever a person swallows food
Trachea:
 Windpipe-Main tube connecting nose/mouth to lungs.
Bronchi:
 Two tubes inside lungs through which air passes to the
bronchioles.
Bronchioles:
Small branching out tubes(0.1 cm diameter)
Alveoli: Tiny air sacs that do the oxidation and the exhale of
CO2.
Capillaries:
Blood vessels in the walls of the alveoli.
While in the capillaries the blood discharges carbon dioxide
into the alveoli and takes up oxygen from the air in the
alveoli.
Breathing (respiration) :
Inspiration (inhalation)
Expiration (exhalation)
Inspiration:
Diaphragm(The diaphragm is a dome-shaped muscle below
the lungs that controls breathing) contracts and pulls
downward while the muscles between the ribs contract and
pull upward.
This increases the size of the thoracic cavity and decreases
the pressure inside.
As a result, air rushes in and fills the lungs.
Expiration:
Diaphragm relaxes, and the volume of the thoracic cavity
decreases
The pressure within it increases. As a result, the lungs
contract and air is forced out
 Working
The primary organs lungs  take in oxygen and expel CO2 as
we breathe.
The gas exchange process is performed by the lungs and
respiratory system.
Air, a mix of oxygen and other gases, is inhaled.
Air that flows from the mouth or nasal cavity travels through the
pharynx and moves down to the trachea.
Then the air moves to the bronchi tubes as they enter the lungs.
In the throat, the trachea filters the air.
The trachea branches into two bronchi, tubes that lead to the
lungs.
Once in the lungs, oxygen is moved into the bloodstream.
Blood carries the oxygen through the body to where it is needed.
Red blood cells collect CO2 from the body’s cells and
transports it back to the lungs.
Exchange of oxygen and carbon dioxide takes place in the
alveoli, small structures within the lungs.
CO2, a waste gas, is exhaled and the cycle begins again with the
next breath.
The diaphragm flattens out and pulls forward, drawing air into
the lungs for inhalation.
During exhalation the diaphragm expands to force air out of
the lungs.
Adults normally take 12 to 20 breaths per minute.
 Respiratory parameters
3 basic measurements:
Ventilation
Ability of body to move volumes of air
Speed with which air moves in the body
Distribution
Where gas flows in the lungs
Whether disease has closed any section to air flow
Diffusion
Ability to exchange gas with circulatory system
Tests are performed to determine the volumes and capacity of
respiratory system
Volume of air associated with different phases of the
respiratory cycle
Lung volumes are directly measured
Lung capacities are inferred from lung volumes
 Respiratory parameters

I. Respiratory Volumes (RV)

a) Tidal Volume (TV)
b) Inspiratory Reserve Volume (IRV)
c) Expiratory Reserve Volume (ERV)
d) Residual Volume (RV)
a) Tidal Volume (TV)
Normal volume of air inspired or expired during quiet
breathing
TV  about 500 ml for men & women

b) Inspiratory Reserve Volume (IRV)

Extra volume of air that can be inhaled with maximal effort
after reaching the normal end inspiratory level
End inspiratory level is the level reached at the end of
normal, quiet inspiration
About 3,000 ml for men & 2,000 ml for women
c) Expiratory Reserve Volume (ERV)
Extra volume of air that can be expired with maximum
effort beyond the normal end expiratory level
End expiratory level is the level reached at the end of
normal, quiet expiration
About 1200 ml for men & 700 ml for women

d) Residual Volume (RV)

Volume of gas remaining in the lungs at the end of maximal
expiration
About 1,200 ml in men & women
Minute Volume(MV)
Volume of gas exchanged per minute during quiet breathing
MV= TV x Breathing rate

Alveolar Ventilation(AV)
Volume of fresh air entering the alveoli with each breath
AV= Breathing rate x (TV – dead space)
II. Respiratory (lung) Capacities
 Two or more respiratory volumes added together
1. Vital Capacity (VC)
2. Total Lung Capacity (TLC)
3. Inspiratory Capacity (IC)
4. Functional Residual Capacity(FRC)
1. Vital Capacity(VC)
 Max Amount of air expelled after deepest possible
inspiration
 VC = TV+IRV+ERV

2. Total Lung Capacity(VLC)

 Volume of air present in the lung at the end of maximal
inspiration
 TLC = VC + RV
3. Inspiratory Capacity(IC)
 Max volume of air that can be inspired after reaching the
end expiratory level
 IC = TV+IRV

4. Functional Residual Capacity(FRC)

 Volume of air remaining in lungs at the end expiratory
level
 FRC= ERV + RV
Significance of FRC
Continues exchange of gases
So that conc. of O2 and C O2 is maintained
Breath holding is made possible
Dilution of toxic inhaled gases
Prevents collapse of lungs
Reduces workload of respiratory muscles and right ventricle
Dead space
Functional volume of lung that doesn’t participate in gas
exchange
 Maximum inspiratory level

Resting expiratory level

Maximum expiratory level

III. Dynamic Respiratory Parameters
 Parameters measured during forced breathing tests

1. Forced Vital Capacity(FVC)

 Amount of air that can be forcibly exhaled from the lungs
as quickly as possible after taking the deepest possible
breath

2. Forced Expiratory Volume(FEV)

 % of the VC that can be forced out of the lungs in a given
period with maximal exertion
3. Maximum Mid-Expiratory low(MMEF)
 Forced expiratory flow (FEF) Rate of airflow recorded
in measurements of forced vital capacity
 The portion between 25 and 75 per cent of forced vital
capacity MMEF

4. Mid Expiratory Time(MET)

Time over which thus volume is forcefully exhaled