NMS
5/5/99

Dis-ease—over excitation of tissues
Disease—under excitation of tissues

Exam
1.	sensory
2.	motor
3.	reflex

Sensory
1.	pain—spinothalamic tract (lateral and anterior)
2.	proprioception—travels over the dorsal columns, decussates later
•	all sensory ends up on the opposite of the brain than it was detected
•	lesion that affects both pain and proprioception is found in the peripheral nerve
•	if have a lesion in the plexus, affect both (thoracic outlet syndrome)
•	in IVF both are affected
•	once through the IVF the two separate—Spinal lesions separate tracts
•	in the brain, pain and proprioception are brought back together
•	need to look for the deficits in the exam
•	does the patient feel pain
•	does the patient feel vibration
•	if lose one and retain the other, these are very serious spinal cord injuries
•	ablative—lesion in the CNS of the spine, first thing to disappear is pain, the patient starts to feel numbness—destructive lesion

Subluxation
•	90% is Dis-ease--conduction, (-) neurologic signs
•	10% is disease-- conduction, (+) neurologic signs
PND—progressive neurologic deficit

Pain-- Hints from the Hx of C/C
Pain is always perceived at the terminal end of the nerve
1.	Dis-ease (90%)
a.	dull/achy
b.	deep
c.	poorly localized
2.	Disease (10%)--neuropathies
a.	burning and sharp
b.	superficial
c.	somatotopically discriminated (pt knows where the pain is)
d.	paresthesia that is tingling (always a sign)—if pt feels paresthesia it has to be disease
•	diabetes, lack of vit B
•	whether the leseion is in the peripheral nerve, the plexus, cell body (ganglion), root, cord, brain, there will be tingling that is disrupted conduction