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Nervous System Basics and the Central Nervous System

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Nervous System Basics and the Central Nervous System Powered By Docstoc
					Elsevier
                                   MO
     Storyboard for Module 4, Lesson 4
Document Information
Reference
Date                     August 21, 2011
Author                   Sandy Fritz
Modified By
Instructional Designer   Joan Saliskas
Module                   Module 4, Nervous System Basics And The Central Nervous System,
                         Lesson 4




MO                                         1 of 105
Document History
The following table states the build and revision history of the document:
 Version           Date              Modified by                            Reason
               10/23 – 10/26            Joan            Put in template, comments, questions.
                   10/27               Sandy            Answers.
     `             10/27                Joan            Changes.
                   10/27               Sandy            Answers.
                 10/27 and              Joan            Changes.
                   10/28



Global Engineering Notes
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Module Outline
Module Title                             Module 4, Nervous System Basics And The Central Nervous System,
                                         Lesson 4
Lesson Introduction .............................................................................................................................. 5
Reading Assignment ............................................................................................................................ 6
Are You Reading Your Textbook? ....................................................................................................... 7
Disorders of the Nervous Tissue and the Brain ................................................................................ 9
That Was Boring .................................................................................................................................. 14
Let’s Go on a Field Trip to New York, NY ......................................................................................... 16
Labeling the Rear ................................................................................................................................ 18
A Really Reliable Information Source ............................................................................................... 19
Grab Bag .............................................................................................................................................. 21
Pathology Category: Injury/Trauma .................................................................................................. 23
Websites for Additional Study ........................................................................................................... 25
Strokes: Brain Damage ....................................................................................................................... 27
Massage and Brain Injury................................................................................................................... 30
Back to Basics ..................................................................................................................................... 32
Pathology Category: Disease/Deterioration ..................................................................................... 33
Viral Infection ...................................................................................................................................... 35
Websites for Additional Study ........................................................................................................... 37
Grab Bag .............................................................................................................................................. 39
Pathology Category: Mental Illness .................................................................................................. 42
Websites for Additional Study ........................................................................................................... 44
Mental Health ....................................................................................................................................... 46
Let’s Go to the Movies ........................................................................................................................ 50
Spinal Cord Pathology........................................................................................................................ 54
Symptoms of Spinal Cord Injury ....................................................................................................... 56
Birth Defects ........................................................................................................................................ 58
Websites for Additional Study ........................................................................................................... 60
CNS PATHOLOGY ............................................................................................................................... 63
The Clinical Reasoning Process to Manage Headache, Part One: Gather Facts ......................... 65
Primary and Secondary Headache Types ........................................................................................ 69
Predisposing Factors for Developing Headache ............................................................................. 71
The Clinical Reasoning Process to Manage Headache, Part Two: Consider Possibilities ......... 73
Massage for Pain ................................................................................................................................. 75
How Massage Produces Beneficial Effects ...................................................................................... 77
The Clinical Reasoning Process to Manage Headache, Part Three: What Is the Plan? .............. 79
Massage for Tension Headaches ...................................................................................................... 82


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Lesson Summary ................................................................................................................................ 84
Lesson Review .................................................................................................................................... 85
Module Case Study ............................................................................................................................. 90
Module Summary ................................................................................................................................ 93
Module Exam ....................................................................................................................................... 95




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Screen Type      Lesson Introduction
                 Nervous System Basics And The Central Nervous System
Module Title
                 Central Nervous System Pathology
Lesson Title
                 Lesson Introduction
Screen Title
                 LESSON INTRODUCTION
Screen Icon

On Screen Text   In this final lesson of module four, we will learn about injury and disease that
                 affects the central nervous system. We will divide the pathological conditions into
                 the following categories:
                      Injury/trauma
                      Disease/deterioration
                      Mental health
                      Substance abuse
                 In each segment, we will describe indications and contraindications for massage
                 and explore references that can be used to learn about the condition. Animations
                 will help you better understand central nervous system pathology.
                 We will also consider specific recommendations for massage application to help
                 relieve headaches. The grab bag still has some fun stuff in it, so make sure to
                 explore what‘s in there.




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                            Source         Description         Alternate Text

                     Item: #3658429                          What‘s wrong in
                                                             there?

                     Item: #5064377                          Central nervous
                                                             system disease




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                  Nervous System Basics And The Central Nervous System
Module Title
                  Central Nervous System Pathology
Lesson Title
                  Reading Assignment
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                  READING ASSIGNMENT
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On Screen Text




                                Reading Assignment: pp. 98 -- 106




                  Click Next to continue.

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                           Source       On Screen Link        Description    Alternate Text

                   Textbook image                         Textbook image    Textbook




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Screen         General Content
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               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
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               Are You Reading Your Textbook?
Screen Title

On Screen      Just a reminder, this course does not replace your textbook. It enhances all the
Text           information and brings the content to life for you.
               The online course takes you places in the virtual world that your textbook cannot, but
               the textbook provides information that you need to know that is not covered in this
               course. The way to best learn is to do the textbook reading and activities along with the
               online course. Your textbook should be open at your side.
               Also remember all the good stuff on the Evolve site for each chapter in the textbook.
               The DVD in the textbook has great animations and dissection clips for you. There is a
               really great view of the brain on the DVD.
               The assumption is that you are an adult learner and you really want to be an excellent
               massage therapist. You are not in high school doing stuff because you have to.
               Instead, you are learning because you want to. Make the most of all of your resources.
               A responsible and professional learner leads to a responsible and professional
               massage therapist.



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              Item: #5087442                                                   Wise ole owl
                                                                               checking on ya




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               Nervous System Basics And The Central Nervous System
Module
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               Central Nervous System Pathology
Lesson
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               Disorders of the Nervous Tissue and the Brain
Screen Title

On Screen      Following is a listing in alphabetical order of the major pathological conditions of the
Text           central nervous system. Click on each to learn more.
                    Alcohol-induced neurotoxicity
                    Alzheimer's disease
                    Cerebral Palsy (CP)
                    Cerebrovascular accident (CVA)
                    Concussion
                    Contusion
                    Epilepsy
                    Headache
                    Headache – Migraine
                    Hematomas
                    Inflammations
                    Tumors



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                   Link in Onscreen     Alcohol-induced neurotoxicity
                   Text

                   Pop-Up Title         Alcohol-Induced Neurotoxicity

                   Pop-Up Content       Alcohol-induced neurotoxicity is chronic and excessive
                                        ingestion of alcohol causing irreversible injury to the
                                        nervous system. The result is mental deterioration, loss
                                        of memory, inability to concentrate, irritability, and
                                        uncoordinated movement.

                   Link in Onscreen     Alzheimer's disease
                   Text


                   Pop-Up Title         Alzheimer’s Disease


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         Pop-Up Content     Alzheimer‘s disease is a degenerative disease of the
                            brain, usually occurring in older persons. Alzheimer's
                            disease is characterized by progressive loss of memory
                            and impaired intellectual function. Evidence suggests
                            brain atrophy, especially of the frontal and temporal
                            lobes.

         Link in Onscreen   Cerebral Palsy (CP)
         Text


         Pop-Up Title       Cerebral Palsy

         Pop-Up Content     Cerebral palsy (CP) is a group of neuromuscular
                            disorders that result from injury to an infant before,
                            during, or shortly after birth. All forms of CP cause
                            impairment of skeletal muscle activity. Mental
                            retardation and speech difficulties may accompany the
                            disorder.
                            Remember, however, that most individuals with CP
                            have normal intelligence and it it is the speech difficulty
                            that most often impairs communication.

         Link in Onscreen   Cerebrovascular accident (CVA)
         Text


         Pop-Up Title       Cerebrovascular Accident

         Pop-Up Content     Cerebrovascular accident (CVA) is commonly called a
                            stroke, or ―brain attack.‖ A CVA is due to a sudden lack
                            of blood, causing oxygen deprivation and brain
                            damage. Depending on the location and severity of the
                            brain damage, a CVA can result in loss of sensory and
                            motor function (causing paralysis) and speech
                            impairment.
                            The major causes of CVA are thrombosis and cerebral
                            hemorrhage. The hemorrhage may be due to a
                            ruptured aneurysm, such as a Berry aneurysm (a
                            congenital aneurysm of the Circle of Willis, a collection
                            of blood vessels at the base of the brain).

         Link in Onscreen   Concussion
         Text

         Pop-Up Title       Concussion

         Pop-Up Content     A concussion is a transient loss of consciousness,
                            usually after head trauma. A concussion of any type is
                            a serious injury and should be monitored carefully by a
                            physician. Always refer for immediate medical attention
                            if concussion is suspected. Multiple concussions can
                            result in permanent brain damage.



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         Link in Onscreen   Epilepsy
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         Pop-Up Title       Epilepsy

         Pop-Up Content     Epilepsy refers to a group of symptoms that have many
                            causes (such as brain tumor, toxins, trauma, or fever).
                            Neurons in the brain fire suddenly and unpredictably.
                            Grand mal seizures occur when the motor areas fire
                            repetitively, causing convulsive seizures and loss of
                            consciousness. Petit mal seizures occur when sensory
                            areas are affected. Although a brief period of altered
                            consciousness occurs, petit mal seizures are not
                            accompanied by convulsions or prolonged
                            unconsciousness.

         Link in Onscreen   Headache
         Text

         Pop-Up Title       Headache

         Pop-Up Content     A simple tension headache may develop when a
                            person is anxious or tense. Headaches may also
                            develop in response to increased intracranial pressure,
                            irritation of the meninges, and spasm of the cerebral
                            blood vessels.

         Link in Onscreen   Headache—Migraine
         Text


         Pop-Up Title       Headache—Migraine

         Pop-Up Content     Migraine headaches are severe, recurring headaches
                            that usually affect only one side of the head. A migraine
                            may be preceded and accompanied by fatigue, nausea,
                            vomiting, and a visual sensation of zig-zag lines.

         Link in Onscreen   Hematomas
         Text

         Pop-Up Title       Hematomas

         Pop-Up Content     Hematomas are blood clots generally caused by
                            trauma. An epidural hematoma forms between the dura
                            and the skull. A subdural hematoma forms under the
                            dura mater. As the hematoma enlarges, it compresses
                            the brain, elevates intracranial pressure, and can cause
                            death unless the pressure is relieved.

         Link in Onscreen   Inflammations
         Text

         Pop-Up Title       Inflammations

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           Pop-Up Content      Inflammations are encephalitis and meningitis.
                               Encephalitis is an inflammation of the brain usually
                               caused by a virus. Meningitis is an inflammation of the
                               meninges, caused by viruses and bacteria.
                               Inflammation can also occur secondary to head trauma
                               such as contusion.

           Link in Onscreen    Tumors
           Text

           Pop-Up Title        Tumors

           Pop-Up Content      Tumors are malignant and benign tumors in nervous
                               tissue. The tumors can destroy nervous tissue, exert
                               pressure on surrounding structures, and cause a life-
                               threatening increase in intracranial pressure.
                               Examples of tumors include:
                                  Gliomas (malignant tumors arising from glial tissue,
                                   such as an astrocytoma)
                                  Meningiomas (tumors arising from the meninges)
                                  Neuromas (tumors arising from the nerves)



           Link in Onscreen    Contusion
           Text


           Pop-Up Title        Contusion

           Pop-Up Content      A contusion is a bruise of the brain involving a torn
                               cerebral or meningeal blood vessel. A contusion of any
                               type is a serious injury and should be monitored
                               carefully by a physician. Always refer for immediate
                               medical attention if contusion is suspected.




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              Item: #4909941                                                  Lecture




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Screen         General Content
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               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               That Was Boring
Screen Title

On Screen      Remember what we learned about learning in the previous lesson? The previous
Text           screen with the pathologies and definitions was not very relevant, engaging, or fun. It
               got the job done. Major central nervous system pathologies were described, but did
               you learn anything?
               Heads up (brain is in there), when you encounter a boring presentation of information
               you will need to make it exciting yourself. After all, you are an adult learner, right?




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                Link in Onscreen        an adult learner, right?
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                Pop-Up Title            Of course, I am an adult learner!

                Pop-Up Content          Item: #4936728




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                External Site URL




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              Item: #5088546                                                  Boring




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                 Nervous System Basics And The Central Nervous System
Module Title
                 Central Nervous System Pathology
Lesson Title
                 Let’s Go on a Field Trip to New York, NY
Screen Title
                 WEBQUEST
Screen Icon

On Screen Text   Go to the New York Online Access to Health (NOAH). Click on Health Topics, then
                 choose Learning Disorders under Brain and Nervous System, and click on The
                 Basics. Then investigate the difference between learning difference and learning
                 disorder.
                 What did you find? Maybe this?
                 Next find and explore information about dyslexia on the NOAH website.
                 Click to find someone you know who has dyslexia.
                 Finally, stop by and explore nervous system pathology on the website.




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                  Pop-Up Content         Investigators have described as many as 21 variables
                                         that impact the way children learn. Learning styles are
                                         typically composed of psychological, social, sensory,
                                         environmental, and emotional parameters. Surprisingly,
                                         in education, learning differences are not always
                                         appreciated; however, all we have to do is look in the
                                         mirror and we recognize that we all have different
                                         characteristics that make us unique and distinct.



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MO                                      16 of 105
                                     Yup , that‘s me, massage therapist , educator and
                                     author Sandy Fritz.




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                Link in Onscreen     New York Online Access to Health (NOAH)
                Text

                External Site URL    http://noah-health.org/

                Link in Onscreen
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                External Site URL

                Link in Onscreen
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                External Site URL




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                Item: #4552619                          New York




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Module Title       Nervous System Basics And The Central Nervous System
                   Central Nervous System Pathology
Lesson Title
                   Labeling the Rear
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                   SELF-ASSESSMENT ACTIVITY
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                                                   Activity

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 http://coursewareobjects.elsevier.com/objects/Anatomy_and_Physiology/thibodeau_7e/
 common/popup.php?player=fillin.swf&xml=090217.xml&width=573&height=300&name=fillin

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Screen         General Content
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               Nervous System Basics And The Central Nervous System
Module
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               Central Nervous System Pathology
Lesson
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               A Really Reliable Information Source
Screen Title

On Screen      When you study pathology, it is important to have reference sources because it is
Text           impossible to remember all the details of all the possible conditions. The intelligent
               massage therapist knows how to ask an intelligent question to locate a reliable answer.
               Once you look up information, you will need to use clinical reasoning skills to apply the
               information. On screen you see a table with some CNS pathologies listed. You need to
               have a general idea of causes of each pathology and then be able to look up and
               interpret pertinent information relevant to your massage client.
               The National Institute of Neurological Disorders and Stroke (NINDS), part of the
               National Institutes of Health, is a very reliable source. NINDS has a good page on
               Brain Basics where you can review brain anatomy and function.




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Popups          Link in        National Institute of Neurological Disorders and Stroke (NINDS)
                Onscreen
                Text

                External       http://www.ninds.nih.gov/
                Site URL

                Link in        Brain Basics
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                External       http://www.ninds.nih.gov/disorders/brain_basics/know_your_brain.htm


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                                   Source                           On      Description     Alternate
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                                                                   Link

               http://coursewareobjects.elsevier.com/objects/                              Categories
                                                                                           of CNS
               elr/Stevens/pathology3e/IC/images/021037.jpg
                                                                                           pathology




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               Nervous System Basics And The Central Nervous System
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               Central Nervous System Pathology
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               Grab Bag
Screen Title

On Screen      How do the activities we engage in every day affect our brain? Pull from the grab bag
Text           and find out!
                    Your Brain on Google
                    Brains Rule! Neuroscience Exposition Project
                    Center for Behavioral Neuroscience

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                   External Site    http://www.youtube.com/watch?v=NhLnoZFCDBM&feature=channel
                   URL

                   Link in          Brains Rule! Neuroscience Exposition Project
                   Onscreen
                   Text

                   External Site    http://www.brainsrule.com/
                   URL

                   Link in          Center for Behavioral Neuroscience
                   Onscreen
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              External Site    http://www.cbn-atl.org/
              URL




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               Nervous System Basics And The Central Nervous System
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               Central Nervous System Pathology
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               Pathology Category: Injury/Trauma
Screen Title

On Screen      Traumatic brain injury (TBI), a form of acquired brain injury, occurs when a sudden trauma
Text           causes damage to the brain. TBI can result when the head suddenly and violently hits an
               object, or when an object pierces the skull and enters brain tissue.
               Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the
               damage to the brain. A person with a mild TBI may remain conscious or may experience a
               loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include
               headache; confusion; lightheadedness; dizziness; blurred vision or tired eyes; ringing in
               the ears; bad taste in the mouth; fatigue or lethargy; a change in sleep patterns; behavioral
               or mood changes; and trouble with memory, concentration, attention, or thinking.
               A person with a moderate or severe TBI may show these same symptoms, but may also
               have a headache that gets worse or does not go away; repeated vomiting or nausea;
               convulsions or seizures; an inability to awaken from sleep; dilation of one or both pupils of
               the eyes; slurred speech; weakness or numbness in the extremities; loss of coordination;
               and increased confusion, restlessness, or agitation.
               In the figure on the screen, A shows that epidural hemorrhage is caused by trauma and
               rupture of the middle meningeal artery. B shows that subdural hemorrhage is caused by
               traumatic rupture of bridging veins. C shows that subarachnoid hemorrhage is typical of
               ruptured berry aneurysm of the Circle of Willis at the base of the brain. And D shows that
               intracerebral hemorrhage is a complication of hypertension. The most common sites of
               hypertensive hemorrhages are the basal ganglia, pons, and cerebellum.



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`

                                    Source                            On      Description         Alternate
                                                                    Screen                           Text
                                                                     Link

               http://coursewareobjects.elsevier.com/objects/elr/                            Intracranial
                                                                                             hemorrhages
               Damjanov/pathologyHP3e/IC/images/021005.jpg




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               Central Nervous System Pathology
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               Websites for Additional Study
Screen Title

On Screen      The following websites are helpful for ongoing study of traumatic injury to the central
Text           nervous system:
               NINDS has a Traumatic Injury Brain Information page. They also have good
               information about shaken baby syndrome.
               Nova ScienceNOW has a lot of information about brain trauma. You can also find
               information on the website of the Brain Injury Foundation.
               Finally, you can view a story and videos about someone who experienced traumatic
               head injury.


               Click Next to continue.




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Popups          Link in Onscreen     Traumatic Injury Brain Information page
                Text

                External Site URL    http://www.ninds.nih.gov/disorders/tbi/tbi.htm

                Link in Onscreen     shaken baby syndrome
                Text

                External Site URL    http://www.ninds.nih.gov/disorders/shakenbaby/shakenbaby.htm


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              Link in Onscreen    brain trauma
              Text

              External Site URL   http://www.pbs.org/wgbh/nova/sciencenow/0306/02.html

              Link in Onscreen    Brain Injury Foundation
              Text

              External Site URL   http://www.birf.info/index.shtml

              Link in Onscreen    a story
              Text

              External Site URL   http://www.donnywinn.com/

              Link in Onscreen    videos
              Text

              External Site URL   http://www.donnywinn.com/?page_id=991



              Link in Onscreen    traumatic head injury
              Text

              External Site URL   http://www.donnywinn.com/?p=591




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Title
               Central Nervous System Pathology
Lesson
Title
               Strokes: Brain Damage
Screen Title

On Screen      A stroke occurs when the blood supply to part of the brain is suddenly interrupted or
Text           when a blood vessel in the brain bursts, spilling blood into the spaces surrounding
               brain cells. Brain cells die when they no longer receive oxygen and nutrients from the
               blood or there is sudden bleeding into or around the brain.
               The symptoms of a stroke include:
                    Sudden numbness or weakness, especially on one side of the body
                    Sudden confusion or trouble speaking or understanding speech
                    Sudden trouble seeing in one or both eyes
                    Sudden trouble with walking, dizziness, or loss of balance or coordination
                    Sudden severe headache with no known cause
               There are two forms of stroke: Ischemic (blockage of a blood vessel supplying the
               brain) and hemorrhagic (bleeding into or around the brain).
               Read more about strokes. And watch a video clip about the brain damage caused by
               strokes.




Pop-Up


MO                                           27 of 105
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               Link in Onscreen
               Text

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External
Site
Popups         Link in             more about strokes
               Onscreen Text

               External Site       http://www.ninds.nih.gov/disorders/stroke/stroke.htm
               URL

               Link in             brain damage caused by strokes
               Onscreen Text

               External Site       http://www.youtube.com/watch?v=gnZcxJ7MZY4&feature=related
               URL




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Video,
Slides)        Media Type

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               Pop-up                  <<insert details of the media here---provide source
               Content/Source          information if it is a pick-up video or animation; list
                                       image file names and narration if it is a slideshow; list
                                       image files and captions here if you are using a photo
                                       gallery)>>




Engineering   Use the click-to-enlarge function for the image.
Notes

On Screen
Image
                                     Source                            On       Description   Alternate
                                                                     Screen                      Text

MO                                        28 of 105
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Number
                                                              Link

         http://coursewareobjects.elsevier.com/objects/elr/          Large
                                                                     infarct
         Stevens/pathology3e/IC/images/021007.jpg




MO                                  29 of 105
                   13.
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Number

Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Massage and Brain Injury
Screen Title

On Screen      Is massage beneficial for those with brain injury?
Text
               What do you think? Consider the following from an article on the website of the Brain
               Injury Resource Foundation :
               One method used to help evaluate alternative interventions is called Evidence Based
               Medicine. This approach asks four questions about the data supporting each practice,
               procedure, or therapy to help one decide if they are worth trying:
               1. Validity (believability/objectivity)—Is the supporting evidence unbiased, performed by
               knowledgeable researchers and published in a well-respected journal?
               2. Importance (significant difference/benefit)—Did the results of the treatment produce
               a benefit that make it worth the risks? Were the ―statistics‖ truthful and significant?
               3. Applicability (to put into effect)—Is the treatment performed easily, available to most
               people, medically possible, and cost effective ?
               4. Purpose (does it help or changed something that makes life better)—Does it do what
               it should, and does it work in all populations?
               If a therapy does not meet any of these criteria, then a useful question is: Are the time,
               money, emotional investment, and potential medical complications that could occur
               merited by the potential benefit of this treatment?




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External
Site


MO                                          30 of 105
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              Link in Onscreen    an article
              Text

              External Site URL   http://www.birf.info/home/library/alt-
                                  med/altmedlib_overview.html

              Link in Onscreen
              Text

              External Site URL




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              Pop-up              <<insert details of the media here---provide source
              Content/Source      information if it is a pick-up video or animation; list
                                  image file names and narration if it is a slideshow; list
                                  image files and captions here if you are using a photo
                                  gallery)>>




Engineering
Notes

On Screen
Image
                      Source      On Screen Link            Description          Alternate Text

              Item: #4823995                                                  What do you
                                                                              think?




MO                                   31 of 105
                         14.
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Screen Type          Learning Activity – Inline Engine

Module Title         Nervous System Basics And The Central Nervous System
                     Central Nervous System Pathology
Lesson Title
                     Back to Basics
Screen Title
                     SELF-ASSESSMENT ACTIVITY
Screen Icon

On Screen Text




 Pickup Source

 http://coursewareobjects.elsevier.com/objects/elr/Solomon/introAP3e/bodyspectrum/SWDirectorpage.html?dcr=bSpecCh3.d

INSERT ENGINE TEMPLATE(S) HERE (Make sure cursor is in front of ―INSERT‖)

On Screen Image

                               Source                On Screen Link          Description            Alternate Text




     MO                                       32 of 105
                   15.
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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Pathology Category: Disease/Deterioration
Screen Title

On Screen      Bacterial infections of the central nervous system. Infectious organisms may reach the brain
Text           through several routes: hematogenously, by direct entry secondary to penetrating trauma, or by direct
               spread from adjacent structures such as the inner ear or the nasal sinuses.
               Degenerative diseases of the brain preferentially involve various parts of the brain. Alzheimer‘s
               disease causes atrophy of the frontal and occipital cortical gyri. Huntington‘s disease affects the
               frontal cortex and basal ganglia. Parkinson‘s disease is marked by changes in the substantia nigra.
               Amyotrophic lateral sclerosis affects the motor neurons in the anterior horn of the spinal cord,
               brainstem, and frontal cortex of the brain.
               As we age, the brain is more susceptible to disease and deterioration. Beginning about the age of 30,
               the number of neurons decreases. The number lost, however, is only a small percentage of the total
               number of brain cells and does not cause mental impairment. Although a decrease in short-term
               memory may cause some forgetfulness, most memory, alertness, intellectual functioning, and
               creativity remain intact.
               Severe alteration of mental functioning is generally due to age-related diseases such as
               arteriosclerosis. Impulse conduction speed decreases along an axon; amounts of neurotransmitters
               are reduced; and the number of receptor sites decreases at the synapses. These changes result in
               progressive slowing of responses and reflexes. We can prevent some and slow most of this activity
               through physical and mental exercises.




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Site
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                Text


MO                                         33 of 105
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               External Site URL

               Link in Onscreen
               Text

               External Site URL




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               Media Title

               Pop-up                 <<insert details of the media here---provide source
               Content/Source         information if it is a pick-up video or animation; list
                                      image file names and narration if it is a slideshow; list
                                      image files and captions here if you are using a photo
                                      gallery)>>




Engineering   Use the click-to-enlarge function for both on screen images.
Notes

On Screen
Image
                                         Source                                  On       Description     Alternate
                                                                               Screen                        Text
                                                                                Link

               http://coursewareobjects.elsevier.com/objects/elr/Damjanov/                              Brain
                                                                                                        infection
               pathologyHP3e/IC/images/021009.jpg

               http://coursewareobjects.elsevier.com/objects/elr/                                       Degenerative
                                                                                                        disease
               Damjanov/pathologyHP3e/IC/images/021014.jpg




MO                                        34 of 105
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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Viral Infection
Screen Title

On Screen      Viral infections are much harder to treat and have the potential for more serious outcomes
Text           Following are the most common viral infection of the CNS:
               <insert the table on the screen indicated in the Engineering Notes>




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                Text

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                Pop-Up Content




External
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Popups          Link in Onscreen
                Text

                External Site URL

                Link in Onscreen
                Text

                External Site URL




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MO                                         35 of 105
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               Media Type

               Media Title

               Pop-up                  <<insert details of the media here---provide source
               Content/Source          information if it is a pick-up video or animation; list
                                       image file names and narration if it is a slideshow; list
                                       image files and captions here if you are using a photo
                                       gallery)>>




Engineering   Insert the following table on the screen:
Notes
              http://coursewareobjects.elsevier.com/objects/elr/Stevens/pathology3e/IC/images/021025.jpg



On Screen
Image
                        Source            On Screen Link            Description             Alternate Text




MO                                         36 of 105
                   17.
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Number

Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Websites for Additional Study
Screen Title

On Screen      The following websites are helpful for ongoing study of disease/deterioration:
Text
               The Brain Injury Resource Foundation has a section on memory that includes a
               number of solid articles targeted at a wider audience than just those with brain injuries.
               Topics include memory techniques, games to improve your memory, prevention of
               post-stroke impairment, and understanding memory and injury.
               The Alzheimer's Foundation of America has information about Alzheimer's disease and
               related dementias, as well as referrals to local resources for individuals suffering from
               dementia and for their families. Each November, the foundation sponsors National
               Memory Screening Day, with free confidential screenings at sites across the country.
               NPR: H.M.'s Brain and the History of Memory

               Recommended by researcher Suzanne Corkin, who's studied the person called ―H.M.‖
               since the 1960s, this NPR Weekend Edition audio clip gives a good perspective on
               H.M. and the contributions of his case to the study of memory. In 1953, H.M. had
               radical brain surgery for epilepsy that left him with little long-term memory. Some actual
               interviews between H.M. and Corkin are included, as well as a discussion with Brenda
               Milner, the psychologist who did the original testing on H.M.


               Click Next to continue.



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External
Site
Popups          Link in      section on memory

MO                                          37 of 105
                17.
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Number
              Onscreen
              Text

              External      http://www.birf.info/home/library/memory/mem-memtech.html
              Site URL

              Link in       Alzheimer's Foundation of America
              Onscreen
              Text

              External      www.alzfdn.org/
              Site URL

              Link in       NPR Weekend Edition audio clip
              Onscreen
              Text

              External      http://www.npr.org/templates/story/story.php?storyId=7584970&sc=emaf
              Site URL




Special
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(Animation,   Text
Video,
Slides)       Media Type

              Media Title

              Pop-up                  <<insert details of the media here---provide source
              Content/Source          information if it is a pick-up video or animation; list
                                      image file names and narration if it is a slideshow; list
                                      image files and captions here if you are using a photo
                                      gallery)>>




Engineering
Notes

On Screen
Image
                      Source          On Screen Link            Description          Alternate Text

              Item: #3655341                                                      Memory search




MO                                       38 of 105
                     18.
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Number

Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Grab Bag
Screen Title

On Screen      More interesting stuff in the grab bag. It is an ongoing source of mostly relevant information and occasion
Text           non-relevant information, just to keep you interested.
                    Understanding Blindness and the Brain
                    Brain Science – Behind the Scenes
                     Anatomy: Central Nervous System
                    Keeping a Healthy Brain
                    The Brain Gym
                    Brain Break



Pop-Up
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                   Link in Onscreen
                   Text

                   Pop-Up Title

                   Pop-Up Content




External
Site
Popups             Link in    Understanding Blindness and the Brain
                   Onscreen
                   Text

                   External   http://www.youtube.com/watch?v=VVgfC_FV2hI&feature=SeriesPlayList&p=32BC95C9D7
                   Site URL

                   Link in    Brain Science – Behind the Scenes
                   Onscreen
                   Text

                   External   http://www.youtube.com/watch?v=phr9a3v9hJI&feature=channel
                   Site URL


MO                                         39 of 105
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              Link in       Anatomy: Central Nervous System
              Onscreen
              Text

              External      http://www.youtube.com/watch?v=BcGRUr1_6gc&feature=related
              Site URL

              Link in       Keeping a Healthy Brain
              Onscreen
              Text

              External      http://www.youtube.com/watch?v=z743qCPO_58&NR=1
              Site URL

              Link in       The Brain Gym
              Onscreen
              Text

              External      http://www.youtube.com/watch?v=N7sEJqtc8zA&feature=channel
              Site URL

              Link in       Brain Break
              Onscreen
              Text

              External      http://www.sillycats.net/
              Site URL




Special
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(Animation,   Text
Video,
Slides)       Media Type

              Media Title

              Pop-up                   <<insert details of the media here---provide source
              Content/Source           information if it is a pick-up video or animation; list
                                       image file names and narration if it is a slideshow; list
                                       image files and captions here if you are using a photo
                                       gallery)>>




Engineering
Notes



MO                                         40 of 105
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Number

On Screen
Image
                    Source   On Screen Link   Description   Alternate Text

            Item: #5353532




MO                            41 of 105
                   19.
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Number

Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Pathology Category: Mental Illness
Screen Title

On Screen      Mental illness is any health condition that changes a person‘s thinking, feelings, and/ or
Text           behavior and that causes the person distress and difficulty in functioning. Many types
               of mental illness can be classified in two major categories: anxiety and depression.
               Most mental illness involves neurotransmitter and /or hormonal imbalances. Much of
               substance abuse is actually self-medicating for mental illness. Recreational use of
               substances that alter mental functioning can unfortunately result in long-term mental
               illness.
               The National Institute of Mental Health (NIMH), part of the National Institutes of Health
               (NIH), a component of the U.S. Department of Health and Human Services, is an
               excellent resource for learning specifics about mental illness and mental health. NIH
               also offers a course about mental illness.
               You can also view a video about new treatments for depression and other psychiatric
               diseases by sending pulses of light into the brain.




Pop-Up
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                Text

                Pop-Up Title

                Pop-Up Content




External
Site
Popups          Link in Onscreen        National Institute of Mental Health (NIMH)
                Text

                External Site URL       http://www.nimh.nih.gov/index.shtml




MO                                          42 of 105
                19.
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Number

              Link in Onscreen    course about mental illness
              Text

              External Site URL   http://science-education.nih.gov/customers.nsf/MSMental

              Link in Onscreen    new treatments
              Text

              External Site URL   http://www.youtube.com/watch?v=C8bPbHuOZXg&NR=1




Special
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Asset         Link in Onscreen
(Animation,   Text
Video,
Slides)       Media Type

              Media Title

              Pop-up              <<insert details of the media here---provide source
              Content/Source      information if it is a pick-up video or animation; list
                                  image file names and narration if it is a slideshow; list
                                  image files and captions here if you are using a photo
                                  gallery)>>




Engineering
Notes

On Screen
Image
                      Source      On Screen Link           Description           Alternate Text

              Item: #4824675                                                  Face of depression



              Item: #3187583                                                  The face of anxiety




MO                                   43 of 105
                   20.
Screen
Number

Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Websites for Additional Study
Screen Title

On Screen      The following websites are helpful for ongoing study about substance abuse:
Text
               Monitoring the Future, a study of American youth, provides statistics on the use of a variety
               of illicit and legal drugs, among U.S. middle and high school students, with downloadable
               graphs and charts.
               The National Institute on Drug Abuse (NIDA), a component of the National Institutes of
               Heath (NIH), created a Web site to educate adolescents ages 11 through 15 (as well as
               their parents and teachers) on the science behind drug abuse. NIDA enlisted the help of
               teens in developing the site to ensure that the content addresses appropriate questions
               and timely concerns.
               The Substance Abuse & Mental Health Services Administration of the U.S. Department of
               Health and Human Services offers free publications under the Addiction Treatment section
               of their website. Also available are links for teens, news, and resources on treatment.




Pop-Up
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                Text

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External
Site
Popups          Link in Onscreen        a Web site to educate adolescents
                Text

                External Site URL       http://teens.drugabuse.gov/

                Link in Onscreen        Substance Abuse & Mental Health Services
                Text                    Administration



MO                                         44 of 105
                20.
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              External Site URL      http://www.samhsa.gov/

              Link in Onscreen       Monitoring the Future
              Text

              External Site URL      http://www.monitoringthefuture.org/




Special
Medial
Asset         Link in Onscreen
(Animation,   Text
Video,
Slides)       Media Type

              Media Title

              Pop-up                 <<insert details of the media here---provide source
              Content/Source         information if it is a pick-up video or animation; list
                                     image file names and narration if it is a slideshow; list
                                     image files and captions here if you are using a photo
                                     gallery)>>




Engineering
Notes

On Screen
Image
                                    Source                              On      Description      Alternate
                                                                      Screen                        Text
                                                                       Link

              http://coursewareobjects.elsevier.com/objects/                                     Pathologic
                                                                                                 changes
              elr/Damjanov/pathologyHP3e/IC/images/021013.jpg
                                                                                                 in the
                                                                                                 nervous
                                                                                                 system
                                                                                                 caused by
                                                                                                 chronic
                                                                                                 alcoholism




MO                                      45 of 105
                   21.
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Number

Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Mental Health
Screen Title

On Screen      It is easier to define mental illnesses than to define mental health. What does it mean
Text           to have mental health? Mental health is much more abstract than mental illness.
               Concepts that relate to mental health include the ability to:
                  Enjoy life
                  Love
                  Recover from adversity
                  Have many emotions at appropriate times
                  Maintain balance
                  Be to be adaptable
                  Empathize
                  Become our real selves
                  Cooperate
                  Play
                  Laugh
                  Cry
                  Lead
                  Follow
                  Be assertive
                  Ability to grieve
                  Be hopeful


               View the photo gallery for the many faces and emotions of mental health.
               <<photo gallery icon>>
               Mental Health




MO                                          46 of 105
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External
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Popups        Link in Onscreen
              Text

              External Site URL

              Link in Onscreen
              Text

              External Site URL




Special
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Asset         Link in Onscreen    Mental Health
(Animation,   Text
Video,
Slides)
              Media Type          Photo Gallery

              Media Title         Mental Health



              Pop-up              Item: #3182273
              Content/Source
                                  Label: Friends

                                  Item: #4861126
                                  Label: Companionship

                                  Item: #6297374
                                  Label: Hope

                                  Item: #4134542
                                  Label: Achievement



MO                                   47 of 105
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                    Item: #4854464
                    Label: Sad

                    Item: #10598704
                    Label: Happy

                    Item: #6297445
                    Label: Contemplative

                    Item: #5803931
                    Label: Giggles

                    Item: #10002411
                    Label: Community

                    Item: #6297342
                    Label: Disappointment

                    Item: #4824795
                    Label: Peace

                    Item: #6297328
                    Label: Mad

                    Item: #5088607
                    Label: Surprise

                    Item: #3669345
                    Label: Family

                    Item: #6297289
                    Label: Teamwork

                    Item: #5258496
                    Label: Blessings

                    Item: #6308893
                    Label: Love




Engineering
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MO                     48 of 105
            21.
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                  Source   On Screen Link   Description   Alternate Text




MO                            49 of 105
                   22.
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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Let’s Go to the Movies
Screen Title

On Screen      Now showing at the movies: Central Nervous System Pathology. Starring: bacteria,
Text           terrorist cells, malfunctioning neurotransmitters, blood clots, and amyloid plaques.
               View these animations.
               <<photo gallery icon>>
               Tumor biopsy
               Meningitis
               Alzheimer’s disease
               Epidural hematoma
               Subdural hematoma
               Parkinson’s disease
               Transient ischemic attack



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                Link in Onscreen
                Text



MO                                         50 of 105
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              External Site URL

              Link in Onscreen
              Text

              External Site URL

              Link in Onscreen
              Text

              External Site URL

              Link in Onscreen
              Text

              External Site URL

              Link in Onscreen
              Text

              External Site URL

              Link in Onscreen
              Text

              External Site URL

              Link in Onscreen
              Text

              External Site URL




Special
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Asset         Link in             Tumor Biopsy
(Animation,   Onscreen Text
Video,
Slides)       Media Type          Animation

              Media Title

              Pop-up              http://www.coursewareobjects.com/objects/archie_narration/233.mov
              Content/Source


              Link in             Meningitis
              Onscreen Text

              Media Type          Animation



MO                                        51 of 105
           22.
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         Media Title

         Pop-up           http://www.coursewareobjects.com/objects/archie_narration/404.mov
         Content/Source


         Link in          Alzheimer’s disease
         Onscreen Text


         Media Type       Animation

         Media Title

         Pop-up           http://www.coursewareobjects.com/objects/archie_narration/416.mov
         Content/Source


         Link in          Epidural hematoma
         Onscreen Text

         Media Type       Animation

         Media Title

         Pop-up           http://www.coursewareobjects.com/objects/archie_narration/417.mov
         Content/Source


         Link in          Subdural hematoma
         Onscreen Text

         Media Type       Animation

         Media Title

         Pop-up           http://www.coursewareobjects.com/objects/archie_narration/420.mov
         Content/Source

         Link in          Parkinson’s disease
         Onscreen Text

         Media Type       Animation

         Media Title

         Pop-up           http://www.coursewareobjects.com/objects/archie_narration/419.mov
         Content/Source


         Link in          Transient ischemic attack
         Onscreen Text

         Media Type       Animation



MO                                52 of 105
                22.
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              Media Title

              Pop-up           http://www.coursewareobjects.com/objects/archie_narration/560.mov
              Content/Source




Engineering
Notes

On Screen
Image
                      Source         On Screen Link         Description         Alternate Text

              Item: #4938060                                                 Got the ticket




MO                                     53 of 105
                     23.
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Number

Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Spinal Cord Pathology
Screen Title

On Screen      Spinal cord pathology is similar to brain pathology. Common pathologies include
Text           trauma, infection, and degeneration, as well as birth defects. Acute and chronic trauma
               to the spine can result in two forms of spinal cord injury:
                    Primary injury at the time of the accident
                    Secondary injury from compression or spinal instability
               There are many causes of spinal cord injury. The more common injuries occur when
               the area of the spine or neck is bent or compressed, as in the following:
                    Birth injuries, which usually affect the spinal cord in the neck area
                    Falls
                    Motor vehicle accidents
                    Sports injuries
                    Diving accidents
                    Trampoline accidents
                    Gunshot and stab wounds




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                   Text

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                   Pop-Up Content




External
Site
Popups             Link in Onscreen
                   Text


MO                                             54 of 105
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              External Site URL

              Link in Onscreen
              Text

              External Site URL




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Asset         Link in Onscreen
(Animation,   Text
Video,
Slides)       Media Type

              Media Title

              Pop-up              <<insert details of the media here---provide source
              Content/Source      information if it is a pick-up video or animation; list
                                  image file names and narration if it is a slideshow; list
                                  image files and captions here if you are using a photo
                                  gallery)>>




Engineering
Notes

On Screen
Image
                      Source      On Screen Link           Description           Alternate Text

              Item: #5304440                                                  Accidents are often
                                                                              responsible




MO                                   55 of 105
                     24.
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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Symptoms of Spinal Cord Injury
Screen Title

On Screen      Symptoms of spinal cord injury vary depending on the severity and location of the
Text           spinal cord injury. At first, the individual may experience spinal shock, which causes
               loss of feeling, muscle movement, and reflexes below the level of injury. Spinal shock
               usually lasts from several hours to several weeks.
               As the period of shock subsides, other symptoms appear, depending on the location of
               the injury. Generally, the higher the level of the injury to the spinal cord, the more
               severe the symptoms. Spinal cord injury is classified according to the person's type of
               loss of motor and sensory function. The following are the main types of classifications:
                    Quadriplegia (quad means four) involves loss of movement and sensation in all
                     four limbs (arms and legs). It usually occurs as a result of injury at T1 or above.
                     Quadriplegia also affects the chest muscles, and injuries at C4 or above require a
                     mechanical breathing machine (ventilator).
                    Paraplegia (para means two like parts) involves loss of movement and sensation
                     in the lower half of the body (right and left legs). It usually occurs as a result of
                     injuries at T1 or below.
                    Triplegia (tri means three) involves the loss of movement and sensation in one
                     arm and both legs and usually results from incomplete SCI.




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                                  image files and captions here if you are using a photo
                                  gallery)>>




Engineering
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                      Source      On Screen Link           Description           Alternate Text

              Item: #5251624                                                   Living with spinal
                                                                               cord injury




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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Birth Defect
Screen Title

On Screen      Spina bifida is a birth defect that involves the incomplete development of the spinal
Text           cord or its coverings. It is a neural tube defect.
               Spina bifida occurs at the end of the first month of pregnancy when the two sides of the
               embryo's spine fail to join together, leaving an open area. The condition usually is
               detected before a baby is born and treated immediately. Babies who are born with
               spina bifida occulta often have no outward signs or symptoms. The spinal cord does
               not protrude through the skin, although a patch of hair, a birthmark, or a dimple may be
               present on the skin over the lower spine. Babies who are born with the meningocele
               form have a fluid-filled sac visible on the back. The sac is often covered by a thin layer
               of skin and can be as small as a grape or as large as a grapefruit.
               Children with spina bifida often have problems with bowel and bladder control and
               various degrees of paralysis. Maternal folic acid deficiency has been linked to spina
               bifida, and researchers believe that many cases can be prevented if women of
               childbearing age consume 0.4 milligrams (400 micrograms) of folic acid every day, and
               continue to take it throughout the first trimester.
               It is important that folic acid consumption start before the onset of pregnancy to provide
               the best protection. Good sources of folic acid include eggs, orange juice, and dark
               green leafy vegetables. Many multivitamins contain the recommended dose of folic
               acid.




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                                   Source                            On       Description   Alternate
                                                                   Screen                      Text
                                                                    Link

              http://coursewareobjects.elsevier.com/objects/elr/                            Spinal
                                                                                            neural
              Stevens/pathology3e/IC/images/021038E.jpg
                                                                                            tube
                                                                                            defects




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Screen         General Content
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               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Websites for Additional Study
Screen Title

On Screen      The following websites are helpful for ongoing study for those of you wanting to be
Text           massage therapists and neuroscientists:
               Birmingham City University has useful information on how medications work on the
               nervous system.
               The National Center for Biotechnology Information offers a bookshelf, which is a
               collection of biomedical books that that you can search. You can search for books on
               the bookshelf for information. Here is an example of the type of information you can
               find using the bookshelf.
               The Society for Neuroscience (SfN) is a great site with extensive educational links.
               Brain Facts is a 74-page primer on the brain and nervous system, published by SfN.
               It was designed for a lay audience as an introduction to neuroscience.
               McGill University runs a very cool site where you can explore all the brain's functions,
               including memory. The brain is presented on five levels: social, psychological,
               neurological, cellular, and molecular.


               Click Next to continue.



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         Site URL

         Link in    Society for Neuroscience (SfN)
         Onscreen
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         External   http://www.ndgo.net/sfn/nerve/
         Site URL

         Link in    a very cool site
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         Text

         External   http://thebrain.mcgill.ca/flash/index_d.html
         Site URL

         Link in    how medications work on the nervous system
         Onscreen
         Text

         External   http://www.hcc.bcu.ac.uk/physiology/Pharmacology01.htm
         Site URL

         Link in    bookshelf
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         External   http://www.ncbi.nlm.nih.gov/sites/entrez?db=books
         Site URL

         Link in    an example
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         External   http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=gnd.chapter.75
         Site URL

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                   Source        On Screen Link          Description          Alternate Text

              Item: #4938110                                               Brain investigation



              Item: #4062038                                               Potential for
                                                                           wisdom




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Screen Type      Learning Activity – Inline Engine

Module Title     Nervous System Basics And The Central Nervous System
                 Central Nervous System Pathology
Lesson Title
                 CNS PATHOLOGY
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                 SELF-ASSESSMENT ACTIVITY
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                               Matching - {fill out the engine template below}

Instructions         Drag the pathologies listed below to their corresponding definitions.



Questions

                            Answers                            Clues                     Media Link
                                                                                      (specify if link is
                                                                                      for clue or
                                                                                      answer)

                      Alzheimer's disease       Disease characterized by early        {insert media
                                                senility, confusion, loss of          link here}
                                                recognition of persons or familiar
                                                surroundings, and restlessness

                      Stroke                    Interruption of blood supply to the
                                                brain, usually resulting in mild to
                                                severe hemiplegia

                      Concussion                Jarring or shaking that results in
                                                injury; brain concussions may be
                                                caused by slight or severe head
                                                injury

                      Multiple sclerosis        Degenerative disease
                                                characterized by sclerotic patches
                                                along the nerves of the central
                                                nervous system where the myelin
                                                sheath has been destroyed

                      Paraplegia                Paralysis from the waist down
                                                caused by damage to the lower


      MO                                       63 of 105
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                                                  level of the spinal cord

                      Parkinson‘s disease         Chronic disease characterized by
                                                  the degeneration of nerves in the
                                                  motor system of the brainstem

                      Convulsion                  Sudden attack with an involuntary
                                                  series of contractions



Distracters          {insert distracters here}




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      MO                                         64 of 105
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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               The Clinical Reasoning Process to Manage Headache, Part One: Gather Facts
Screen Title

On Screen      Headache is a common symptom with a multitude of causes. Headaches can be
Text           caused by stress, muscle tension, chemical imbalance, disordered breathing
               syndromes, nutritional disruption, side effects from medication, vascular dysfunction,
               sinus disorders, tumors, and many more internal and external influences. There are
               two basic headache types:
                    Vascular type—Fluid pressure with pain experienced as throbbing from the inside
                     of the head out, usually classified as migraine, although migraine is only one type
                     of vascular headache.
                    Tension type—Soft tissue shortening, typically called muscle tension headache,
                     although as we will learn that headache is more complicated than a short muscle.
                     This headache is experienced as a squeezing on the outside of the head.
               Because the brain has no sensory innervations, headaches do not originate in the brain
               but in the tissues surrounding the brain and in the muscles of the shoulders, neck, and
               scalp. The pain of a headache is produced by pressure on the sensory nerves, vessels,
               meninges, or the muscle-tendon-bone unit. This pressure is caused from two main
               factors:
                    Fluid pressure from various reasons, including dilation of blood vessels
                    Soft tissue shortening, including connective tissue changes and muscle shortening
               Massage is most effective for the soft tissue shortening headache type and less so for
               the fluid pressure type.




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                   Pop-Up Title          Feels Like My Head Is Going to Explode

                   Pop-Up Content        Item: #4058822

                   Link in Onscreen      Tension type
                   Text

                   Pop-Up Title          Comparison of Tension and Vascular Headaches


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         Pop-Up Content   Columns A and B show the symptoms commonly seen
                          in tension and vascular headaches. Some people have
                          both of these types of headache. It is common for a
                          tension type headache to accompany a vascular type
                          headache.



                                                      A         B
                                  Symptom
                                                      Tension   vascular


                                  Intensity of Pain


                                  Mild to moderate    •         •


                                  Moderate to
                                  severe              •         •


                                  Intense,
                                  pounding,
                                  throbbing and/or
                                  debilitating                  •


                                  Distracting but
                                  not debilitating    •


                                  Steady ache         •


                                  Location of Pain


                                  One side of
                                  head                          •


                                  Both sides of
                                  head                •         •


                                  Associated Symptoms


                                  Nausea/vomiting               •


                                  Sensitivity to
                                  light and/or
                                  sounds                        •


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                                           Aura before
                                           onset of
                                           headache, such
                                           as visual
                                           symptoms                        •




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Engineering
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                      Source      On Screen Link           Description           Alternate Text

              Item: #3665950                                                   Headache


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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Primary and Secondary Headache Types
Screen Title

On Screen      Two types of headaches are primary and secondary:
Text
                    Primary, or benign (not due to other underlying problem): Headaches with no
                     organic or structural etiology, include tension headache, vascular (migraine)
                     headache, cluster headache, and medication-overuse headache (MOH). Most
                     primary headaches develop slowly over minutes, if not hours.
                    Secondary (due to another underlying cause): Headaches due to an underlying
                     structural or organic disease such as those related to a benign or malignant brain
                     tumor, a brain aneurysm, hematoma, meningitis, brain abscess, cerebral
                     hemorrhage, encephalitis or other infection, or various diseases of the brain, eye,
                     ear, nose, etc. Fortunately, less than 5% of headaches are caused by tumors, and
                     not all people with tumors experience headaches. Symptoms of serious headache
                     that require immediate medical attention are a sudden, sharp, intense, or severe
                     headache; sudden lack of balance or falling; confusion; inappropriate behavior;
                     seizures; and difficulty speaking.




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                                  gallery)>>




Engineering
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                      Source      On Screen Link           Description           Alternate Text

              Item: #3684577                                                  Lots of types of
                                                                              headache




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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Predisposing Factors for Developing Headache
Screen Title

On Screen      Three mechanisms seem to be related to developing headaches:
Text
                    A protective mechanism in response to what the body perceives as an external
                     environmental stress. How the body responds to temperature, humidity, and other
                     environmental influence can predispose sensitive individuals to developing
                     vascular headaches. Common triggers of vascular headaches are stress, heat,
                     food, or a lack of sleep. People with predisposition to headache may have a
                     lowered threshold of response to these external stressors.
                    Response to disease due to infections caused by bacteria, viruses, and other
                     pathogens related to the inflammatory response. Consider the muscle aching and
                     headache typically experienced with the flu.
                    Postural distortion, repetitive or sustained movement, and trigger-point referred
                     pain patterns.




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                                  image files and captions here if you are using a photo
                                  gallery)>>




Engineering
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Image
                      Source      On Screen Link           Description           Alternate Text

              Item: #3661241                                                  What causes my
                                                                              headache?




MO                                   72 of 105
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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               The Clinical Reasoning Process to Manage Headache, Part Two: Consider
Screen Title
               Possibilities
On Screen      What else could a headache be?
Text
               While not common, it is important to recognize that headache can be a symptom of a
               much more serious condition that requires immediate medical attention. Individuals
               with a headache that involves any of the following need to be immediately referred for
               prompt medical care.
                    Sudden, severe headache
                    Sudden, severe headache associated with a stiff neck
                    Headache associated with fever
                    Headache associated with convulsions
                    Headache accompanied by confusion or loss of consciousness
                    Headache following a blow on the head
                    Headache associated with pain in the eye or ear
                    Persistent headache in a person who was previously headache-free
                    Recurring headache in children
                    Headache that interferes with normal life




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                      Source      On Screen Link           Description           Alternate Text

              Item: #3665362                                                   How serious is it?




MO                                   74 of 105
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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Massage for Pain
Screen Title

On Screen      The massage professional, as part of a health care team, can contribute valuable
Text           manual therapy in various pain conditions using direct tissue manipulation and reflex
               stimulation of the nervous system and the circulation. As a therapeutic intervention,
               massage may help reduce the need for pain medication, thus reducing the side effects
               of medication.
               Various mechanisms influencing pain are affected during massage: the
               neurotransmitters that perpetuate and inhibit the pain response are affected by
               massage application. The neurochemical most recognized by clients is endorphin.
               Endorphins are part of a group of peptides that act as the body‘s internal pain
               modulator—like morphine. Endorphins have become recognized as part of the
               ―runner‘s high‖ phenomenon.
               Actually, a combination of neurotransmitters and hormones work together to alter pain
               perception; both inhibiting it and/or enhancing it. Massage seems to alter the chemical
               interaction. See chapter five of your text. The pain-inhibiting chemicals influenced by
               massage are from the entire endorphin class, as well as serotonin, GABA, and
               dopamine. The pain-facilitating chemicals influenced by massage are adrenaline,
               noradrenaline, cortisol, and substance P. The research is still scant on just how this all
               works, but what we understand is sufficient for strategic development and justification
               of massage for pain modulation.
               Massage is one of the more effective interventions for managing chronic pain without
               side effects. Touch, vibration, and joint and muscle movement stimulate
               mechanoreceptors, and by stimulating the gate mechanisms, they can decrease the
               pain information received by the brain. Massage stimulates the entire region of the
               body being worked on, along with localized pain areas. A large number of
               mechanoreceptors are stimulated, dramatically reducing the discomfort of working
               deep somatic tissues. This is why full body massage is better for pain management
               than localized spot work.




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              Pop-Up Content




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Notes

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                      Source      On Screen Link           Description           Alternate Text

              Item: #3664453                                                  Apply compression




MO                                   76 of 105
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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               How Massage Produces Beneficial Effects
Screen Title

On Screen      Massage influences the nervous system, central and peripheral (somatic and
Text           autonomic). Application of massage that results in counter-irritation and
               hyperstimulation analgesia functions by activating the gate control for transmission of
               pain signals.
               Reducing mechanical pressure on peripheral somatic nerves by increasing pliability in
               the tissues modulates pain sensation. Stimulation of nociceptors in tissues can be
               reduced by massage.
               Massage can inhibit the proprioceptors. When this occurs, joint function and the muscle
               tension/length relationship normalize, decreasing pain.
               Massage supports parasympathetic dominance, increasing pain tolerance.
               Massage can reduce hydrostatic pressure of edema using lymphatic drain application
               to move interstitial fluid and decrease pressure on pain receptors.
               Massage can alter tissue density, using connective tissue methods to increase ground
               substance pliability or to reduce adhesion from random connective tissue fiber
               distribution.
               Massage exerts a powerful influence on blood movement. Both arterial and venous
               circulation is involved, and massage can target normalization.
               Pain can also occur if circulation is not appropriate. Ischemic tissues are sensitized to
               pain.
               Massage can also have a compassionate and comforting quality that can increase pain
               tolerance.



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                                  gallery)>>




Engineering
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On Screen
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                      Source      On Screen Link           Description           Alternate Text

              Item: #2805090                                                  My headache
                                                                              starts in my neck.




MO                                   78 of 105
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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               The Clinical Reasoning Process to Manage Headache, Part Three: What Is the
Screen Title
               Plan?
On Screen      Massage application targeted to pain management incorporates the following
Text           principles:
               1. General full-body application with a rhythmic and slow approach as often as
                  feasible, with 45- to 60-minute durations.
                  Goal—Parasympathetic dominance with reduced cortisol.
               2. Pressure depth is moderate to deep with compressive broad-based application. No
                  poking, frictioning, or application of pain-causing methods.
                  Goal – Serotonin and GABA support and reduce substance P and adrenaline.
               3. Drag is slight unless connective tissue is being targeted. Drag is targeted to
                  lymphatic drain and skin stimulation.
                  Goal—Reduce swelling and create counter-irritation through skin stimulation.
               4. Nodal points on the body that have a high neurovascular component are massaged
                  with a sufficient depth of pressure to create a ‗good hurt‘ sensation but not
                  defensive guarding or withdrawal. These nodal points are the location of cutaneous
                  nerves, trigger points, acupuncture points, reflexology points, etc. The foot, hands,
                  and head, as well as along the spine, are excellent target locations.
                  Goal—Gate control response, endorphin and other pain-inhibiting chemical
                  release.
               5. Direction of massage varies, but deliberately targets fluid movement.
                  Goal—Circulation support.
               6. Mechanical force introduction of shear, bend, torsion, etc., are of an agitation
                  quality to ‗stir‘ the ground substance and not create inflammation.
                  Goal—Increased tissue pliability and reduced tissue density.
               7. Mechanical force application of shear, bend, and torsion is used to address
                  adhesion or fibrosis but needs to be specifically targeted and limited in duration.
                  Goal—Reduce localized nerve irritation or circulation reduction.
               8. Muscle energy methods and lengthening are applied rhythmically, gently, and
                  targeted to shortened muscles.
                  Goal—Reduce nerve and proprioceptive irritation and circulation inhibition.
               9. Stretching to introduce tension force is applied slowly, without pain and targeted to
                  shortened connective tissue.
                  Goal—Reduce nerve and proprioceptive irritation.
               10. Massage therapists are focused, attentive, compassionate, but maintain
                   appropriate boundaries.
                   Goal—Support entrainment, bioenergy normalization, and palliative care.



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                                  gallery)>>




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         Item: #3665248               Please help




MO                        81 of 105
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Screen         General Content
Type
               Nervous System Basics And The Central Nervous System
Module
Title
               Central Nervous System Pathology
Lesson
Title
               Massage for Tension Headaches
Screen Title

On Screen      Tension headache is the type most successfully treated with massage. The soft tissues
Text           are short and binding and have increased motor and fascial tone. Trigger points can
               occur, and areas of reduced blood flow are common. Massage successfully addresses
               these issues.
               View the slideshow to see the massage strategy for tension headache.
               <<slideshow icon>>
               Massage Strategy for Tension Headache




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                External Site URL

                Link in Onscreen
                Text

                External Site URL




MO                                        82 of 105
                35.
Screen
Number

Special
Medial
Asset         Link in Onscreen   Massage Strategy for Tension Headache
(Animation,   Text
Video,
Slides)
              Media Type         Slideshow

              Media Title        Massage Strategy for Tension Headache

              Pop-up             See the Word file: Fritz MO Module 4 Lesson 4
              Content/Source     Massage Strategy for Tension Headache slideshow
                                 storyboard.




Engineering
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On Screen
Image
                      Source     On Screen Link        Description       Alternate Text




MO                                  83 of 105
                     36.
Screen Number

Screen Type      Lesson Summary
                 Nervous System Basics And The Central Nervous System
Module Title
                 Central Nervous System Pathology
Lesson Title
                 Lesson Summary
Screen Title
                 SUMMARY
Screen Icon

On Screen Text   Central nervous system pathology is somewhat different than other disease
                 processes in that what happens inside the skull is not always visible and therefore
                 recognizable. Traumatic brain injury, various types of mental illness, and
                 headache are examples of potential debilitating pathologies in which the individual
                 does not look sick. Now, with better diagnostic procedures and public awareness,
                 we are becoming more compassionate to those with these conditions.
                 Other CNS pathology is much more apparent, for example, paralysis and infection.
                 Substance abuse is often a form a self-medication indicating the need for
                 appropriate diagnosis and treatment of underlying neurochemical imbalances.
                 Casual recreational use of drugs and alcohol and nicotine can also cause damage.
                 Damage by substance abuse is not limited to the user but potential genetic
                 damage in both males and females can affect their future children and well as
                 damage the fetus during pregnancy. Because substance abuse alters behavior
                 and judgment, injury can extend to those individuals in contact with the user.
                 Finally—never shake a baby!
                 If you‘re confident about the material in this lesson, click Next to do a review
                 activity about what you‘ve learned.



Engineering
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On Screen
Image
                        Source           On Screen Link          Description         Alternate Text

                  Item: #4861098                                                   Potential




MO                                       84 of 105
Screen Number            37.

Screen Type          Activity
                     Nervous System Basics And The Central Nervous System
Module Title
                     Central Nervous System Pathology
Lesson Title

Screen Title         Lesson Review

On Screen Text       Review what you‘ve learned in this lesson by answering the questions below.

{Insert Activities below this text

                Multiple Choice (Framed) - {fill out the engine template below}

 Instructions       Choose the correct answer.

 Question 1         A client is a recovering alcoholic. Which of the following CNS symptoms
                    would this client most likely exhibit?

 Answer                         Answer Choices                   Specific Feedback
 Choices and
                         (Bold the correct response)
 Specific
 Feedback
                    Cerebral palsy

                    Stroke

                    Inability to concentrate

                    Severe sudden headache

 General            Chronic and excessive ingestion of alcohol causes irreversible injury to
 Correct            the nervous system. The result is mental deterioration, loss of memory,
 Feedback           inability to concentrate, irritability, and uncoordinated movement.



 General            Chronic and excessive ingestion of alcohol causes irreversible injury to
 Incorrect          the nervous system. The result is mental deterioration, loss of memory,
 Feedback           inability to concentrate, irritability, and uncoordinated movement.



 Question 2         Which of the following CNS conditions most often begins at infancy?

 Answer                         Answer Choices                   Specific Feedback
 Choices and
                        (Bold the correct response)
 Specific
 Feedback
                    Alzheimer‘s

                    Cerebral palsy

                    Migraine


MO                                          85 of 105
Screen Number       37.

                Tumor

 General        Cerebral palsy is a group of neuromuscular disorders that result from
 Correct        injury to an infant before, during, or shortly after birth.
 Feedback

 General        Cerebral palsy is a group of neuromuscular disorders that result from
 Incorrect      injury to an infant before, during, or shortly after birth.
 Feedback

 Question 3     A client discloses during the pre-massage history that they banged their
                head and saw stars while cleaning out the closet. Which of the following
                conditions is indication for referral?

 Answer                     Answer Choices                    Specific Feedback
 Choices and
                    (Bold the correct response)
 Specific
 Feedback
                Depression

                Anxiety

                Infection

                Concussion

 General        Concussion is a transient loss of consciousness, usually after head
 Correct        trauma. A concussion of any type is a serious injury and should be
 Feedback       monitored carefully by a physician.

 General        Concussion is a transient loss of consciousness, usually after head
 Incorrect      trauma. A concussion of any type is a serious injury and should be
 Feedback       monitored carefully by a physician.

 Question 4     A client has epilepsy that is controlled with medication. Which of the
                following will you need to understand?

 Answer                     Answer Choices                    Specific Feedback
 Choices and
                    (Bold the correct response)
 Specific
 Feedback
                Seizure

                Migraine headache

                Dementia

                Substance abuse

 General        Epilepsy refers to a group of symptoms that have many causes (such
 Correct        as brain tumor, toxins, trauma, or fever). Neurons in the brain fire
 Feedback       suddenly and unpredictably, resulting in seizure.

 General        Epilepsy refers to a group of symptoms that have many causes (such
 Incorrect      as brain tumor, toxins, trauma, or fever). Neurons in the brain fire

MO                                       86 of 105
Screen Number       37.
 Feedback       suddenly and unpredictably, resulting in seizure.

 Question 5     A client tells you that they have a learning disorder. Which of the
                following would be a condition they may have?

 Answer                   Answer Choices                       Specific Feedback
 Choices and
                    (Bold the correct response)
 Specific
 Feedback
                Hematoma

                Visual processing disorder

                Parkinson‘s disease

                Hemiplegia

 General        Visual and auditory processing are the processes of recognizing and
 Correct        interpreting information taken in through the senses of sight and sound.
 Feedback       Disorders in this area would interfere with learning.

 General        Visual and auditory processing are the processes of recognizing and
 Incorrect      interpreting information taken in through the senses of sight and sound.
 Feedback       Disorders in this area would interfere with learning.

 Question 6     A client worries all the time and experiences tension headache and
                insomnia. Which of the follow conditions best describes her symptoms?

 Answer                   Answer Choices                       Specific Feedback
 Choices and
                    (Bold the correct response)
 Specific
 Feedback
                Anxiety

                Schizophrenia

                Meningitis

                Alcoholism

 General        Anxiety involves increased sympathetic ANS activity, explaining worry,
 Correct        headache, and sleep disturbance.
 Feedback

 General        Anxiety involves increased sympathetic ANS activity, explaining worry,
 Incorrect      headache, and sleep disturbance.
 Feedback

 Question 7     A client just celebrated his 60th birthday. He is in good health. Which of
                the following might he begin to experience?

 Answer                   Answer Choices                       Specific Feedback
 Choices and
                    (Bold the correct response)
 Specific
 Feedback
                Dementia



MO                                       87 of 105
Screen Number         37.

                Slowing reflexes

                Memory lapse

                Depression

 General        Age-related CNS changes include slowing of reflex responses.
 Correct
 Feedback

 General        Age-related CNS changes include slowing of reflex responses.
 Incorrect
 Feedback

 Question 8     Which of the following conditions is most directly helped by massage
                therapy?

 Answer                        Answer Choices               Specific Feedback
 Choices and
                     (Bold the correct response)
 Specific
 Feedback
                Infection

                Dementia

                Headache

                Depression

 General        Headache, especially tension headache, can be symptom-managed by
 Correct        massage. The others conditions may be somewhat helped by massage,
 Feedback       but not as much as headache.

 General        Headache, especially tension headache, can be symptom-managed by
 Incorrect      massage. The others conditions may be somewhat helped by massage,
 Feedback       but not as much as headache.

 Question 9     Which of the following symptoms is most indicated for massage therapy
                intervention?

 Answer                     Answer Choices                  Specific Feedback
 Choices and
                     (Bold the correct response)
 Specific
 Feedback
                Pain

                Memory loss

                Irritability

                Substance abuse

 General        Massage therapy can be used for symptom management of a variety of
 Correct        pain conditions.
 Feedback



MO                                         88 of 105
Screen Number         37.

    General       Massage therapy can be used for symptom management of a variety of
    Incorrect     pain conditions.
    Feedback

    Question 10   Which of the following is an indication of a serious CNS condition and
                  considered a medical emergency?

    Answer                  Answer Choices                     Specific Feedback
    Choices and
                     (Bold the correct response)
    Specific
    Feedback
                  Short-term memory loss

                  Upset stomach

                  Insomnia

                  Sudden severe headache

    General       Sudden severe headache is a symptom of stroke, and immediate
    Correct       medical care is required.
    Feedback

    General       Sudden severe headache is a symptom of stroke, and immediate
    Incorrect     medical care is required.
    Feedback

    Engineering
    Notes




}



Engineering
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MO                                         89 of 105
Screen Number        1.

Screen Type      Activity

Module Title     Joints
                 Central Nervous System Pathology
Lesson Title

Screen Title     Module Case Study

On Screen Text   Mrs. Fitch, 32 years old, was in a serious car accident 16 months ago. She experienced
                 multiple injuries, many of which have impacted central nervous system function. She had a
                 skull fracture and developed a secondary bacterial infection. As a result of trauma, Mrs.
                 Fitch has a closed head injury that is affecting her linear reasoning, making it difficult for
                 her to process any sort of sequence such as following a recipe while cooking or instructions
                 for using any sort of appliance.
                 She also experienced a crush injury to the spinal cord in the lumbar area. She is not fully
                 paralyzed but is experiencing weakness in both legs, more so on the left. She is able to
                 walk using a walker for support and is in physical therapy, making slow progressing. She is
                 also depressed and experiencing posttraumatic stress symptoms that are interfering with
                 sleep. She has a lot of pain, including headache. There is concern that she is developing
                 dependency on pain medication.
                 Mrs. Fitch is angry about the accident and obviously stressed. She is unable to work as a
                 retail manager and wonders if she will ever be able to go back to work. Her family and the
                 health care team believe that massage will help manage some of the symptoms and help
                 her in her recovery.
                 You have been asked to analyze her condition and develop a reasonable massage plan.
                 To help you prepare a justifiable massage treatment plan, answer the following questions.
                 Each question will be accompanied by an expert opinion, but it is possible that you could
                 make a case for a different response. If this is the case,you will need to be able to justify
                 your opinion.



External Site
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                  External Site URL




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Image


                            Source              Description             Alternate Text

                  Item: #3666095                                    Mrs. Fitch




MO                                       90 of 105
Screen Number            1.

{Insert Activities below this text

                         Short Answer (Framed) - {fill out the engine template below}

 Instructions         Type your response in the text box. Click ―Submit‖ to compare your answer with that
                      of the expert.



 Question 1           Which of Mrs. Fitch‘s symptoms are most likely to respond to             Media Link
                      massage therapy?
                                                                                               {Insert media
                                                                                               link here}

 Correct Answer       Evidence indicates that pain, sleep disturbance, and stress usually
                      respond to massage application that supports parasympathetic
                      dominance. This aspect of the autonomic nervous system involves
                      regulation of ―rest and relaxation‖ activities.

 Question 2           Which of Mrs. Fitch‘s symptoms are directly related to                   Media Link
                      neurotransmitter dysfunction?



 Correct Answer       The mood and pain-related symptoms have direct neurotransmitter
                      implications. Depression and posttraumatic stress are dopamine-
                      and serotonin-related. Norepinephrine is also involved. Headache
                      pain and sleep disruption were not included because the actual
                      head trauma could be the major cause, and sleep would be more
                      indirectly influenced by neurotransmitters. The substance abuse
                      concern is also related to neurotransmitters, most likely the natural
                      opiates such as endorphin.

 Question 3           Which of Mrs. Fitch‘s symptoms are directly due to the spinal crush      Media Link
                      injury?


 Correct Answer       The only symptom that is directly related to the spinal cord injury is
                      the weakness in her legs. The generalized pain could also be
                      related but is also likely due to other injuries related to the
                      accident.

 Question 4           Which of the symptoms are most related to the head and brain             Media Link
                      trauma?


 Correct Answer       This is a difficult question. The term ―directly‖ related to the head
                      and brain trauma limits the choices. Closed head injury typically
                      results in some sort of cognitive disruption such as the linear
                      processing. Mood is often affected, especially a tendency to
                      frustration and anger. The posttraumatic stress symptoms are
                      likely directly related, but an argument could be made for other
                      influences. The head pain makes sense as being caused by the
                      head trauma.

 Question 5           If able to choose to work with only one of the symptoms that Mrs.        Media Link

MO                                           91 of 105
Screen Number          1.
                     Fitch is experiencing that is most able to be justified by massage-
                     related research, which one would you choose?



    Correct Answer   While a case could be made for massage to affect all of Mrs.
                     Fitch‘s symptoms, the only one that has solid research support is
                     reducing the symptoms of the stress response.

    Question 6       What would be the major contraindications and cautions to              Media Link
                     massage based on the information you have about Mrs. Fitch‘s
                     accident?

    Correct Answer   There had to have been a significant amount of soft tissue injury
                     that may have developed connective tissue changes and altered
                     joint movement. Caution is required with various stretching
                     activities to make sure that joints are not injured and physical
                     therapy treatment is supported.
                     Caution is also required related to medication. The case did not
                     specifically describe the types of medication, but it is likely that
                     pain medication is involved. Depending on the type, caution is
                     involved for increased bruising potential as well as altered sensory
                     perceptions. Pressure depth needs to monitored.
                     The weakness in Mrs. Fitch‘s legs may also be accompanied by
                     altered sensory function. There may be an increase or decrease in
                     muscle tone in the muscles, both of which require caution for
                     massage application.
                     Mrs. Fitch has experienced a life-altering event and has had to
                     adapt to multiple stressors. Her adaptive capacity is limited,
                     making her more susceptible to potential infections. There is
                     concern with mental health issues as well.

    Engineering
    Notes




}



Engineering
Notes




MO                                         92 of 105
                   1.
Screen
Number

Screen         Module Summary
Type
               Nervous System Basics And The Central Nervous System
Module
Title

Lesson
Title
               Module Summary
Screen Title
               SUMMARY
Screen Icon

On Screen      Module four, combined with chapter four in the textbook, covered very interesting information. Each
Text           of the four lessons presented information most related to massage, but the grab bag content
               allowed us to veer off into interesting areas to expand our knowledge.
               We now know that the neuron is the functional unit of the nervous system and that massage
               interacts with nerves by creating sensory stimuli. Neurotransmitters are the chemical aspect of much
               of our behavior. Research also indicates that massage influences neurotransmitters, accounting for
               many of the benefits of massage.
               The brain is a fascinating topic and scientists are still baffled by how it functions. We know more
               every day, but essentially central nervous system function remains a mystery. Content in the grab
               bags provided a glimpse into the advances being made by scientists. We also now understand that
               massage can be used to assist individuals that may have central nervous system pathology when
               we are educated enough to make justifiable decisions about safe and beneficial applications.
               The next module continues with the peripheral aspect of the nervous system. You will quickly realize
               that the information from this module is important for learning more about the somatic and
               autonomic nervous system.


               To begin the exam, click into the Module 4 folder. From there, click Module 4 Exam.

Engineering
Notes

On Screen
Image
                                       Source                             On      Description     Alternate Text
                                                                        Screen
                                                                         Link

                Use C ONLY and crop as shown below                                              Keep laughing –
                http://coursewareobjects.elsevier.com/objects/elr/                              good for
                                                                                                neurotransmitters.
                Fritz/fundamentals4e/IC/jpg/Chapter12/012006AD.jpg

               Crop like this:




MO                                         93 of 105
         1.
Screen
Number




MO            94 of 105
Screen Number           1.

Screen Type        Activity

Module Title       Nervous System Basics And The Central Nervous System

Screen Title       Module Exam

On Screen Text




 Instructions   Choose the correct answer.

 Question 1     A function of neuroglia is to:

 Answer                        Answer Choices                           Specific Feedback
 Choices
                         (Bold the correct response)
 and
 Specific
 Feedback       Transmit signals to the cell body

                Carry signals away from the cell body

                Conduct signals from one neuron to another

                Support and protect neurons

 General        Two types of cells make up the central nervous system: the neurons, which are the
 Correct        functioning cells, and the cells that hold the nervous system together, called
 Feedback       neuroglia.

 General        Two types of cells make up the central nervous system: the neurons, which are the
 Incorrect      functioning cells, and the cells that hold the nervous system together, called
 Feedback       neuroglia.

 Question 2     Neurons that conduct signals to the central nervous system are:

 Answer                        Answer Choices                           Specific Feedback
 Choices
                         (Bold the correct response)
 and
 Specific
                Sensory neurons
 Feedback
                Motor neurons

                Interneurons

                Nodes of Ranvier

 General        Nerve signals that flow to the CNS are sensory.
 Correct
 Feedback

 General        Nerve signals that flow to the CNS are sensory.
 Incorrect

MO                                           95 of 105
Screen Number        1.
 Feedback

 Question 3   Action potential between neurons occurs across the synaptic cleft because of :

 Answer                     Answer Choices                              Specific Feedback
 Choices
                       (Bold the correct response)
 and
 Specific
              Neurotransmitters
 Feedback
              Post-synaptic membrane

              Anterograde transport

              Nodes of Ranvier

 General      Neurotransmitters are the chemicals that carry nerve impulse from one neuron to
 Correct      another.
 Feedback

 General      Neurotransmitters are the chemicals that carry nerve impulse from one neuron to
 Incorrect    another.
 Feedback

 Question 4   The neurotransmitter that primarily excites the skeletal muscles is:

 Answer                     Answer Choices                              Specific Feedback
 Choices
                       (Bold the correct response)
 and
 Specific
              Dopamine
 Feedback
              Acetylcholine

              Serotonin

              Endorphin

 General      Acetylcholine functions with nerve signals related to muscles tissue. Dopamine and
 Correct      serotonin are more involved in ANS function, and endorphin is a pain modulator.
 Feedback

 General      Acetylcholine functions with nerve signals related to muscles tissue. Dopamine and
 Incorrect    serotonin are more involved in ANS function, and endorphin is a pain modulator.
 Feedback

 Question 5   The portion of the brain that interprets sensory data and compares it against past
              memories and experiences is the:

 Answer                     Answer Choices                              Specific Feedback
 Choices
                       (Bold the correct response)
 and
 Specific
              Ventricles
 Feedback
              Pineal body



MO                                       96 of 105
Screen Number           1.

              Cerebrum

              Meninges

 General      One of the many functions of the cerebrum is ―decision-making,‖ or finding the
 Correct      meaning of sensory input.
 Feedback

 General      One of the many functions of the cerebrum is ―decision-making,‖ or finding the
 Incorrect    meaning of sensory input.
 Feedback

 Question 6   The primary area of the brain that would process the color scheme of massage
              therapy room is the:

 Answer                       Answer Choices                             Specific Feedback
 Choices
                         (Bold the correct response)
 and
 Specific
              Frontal lobe
 Feedback
              Parietal lobe

              Temporal lobe

              Occipital lobe

 General      The occipital lobe processes visual data.
 Correct
 Feedback

 General      The occipital lobe processes visual data.
 Incorrect
 Feedback

 Question 7   The area of the brain responsible for primitive emotional feelings is the:


 Answer                       Answer Choices                             Specific Feedback
 Choices
                         (Bold the correct response)
 and
 Specific
              Limbic
 Feedback
              Temporal

              Frontal

              Parietal

 General      The limbic system is the emotional center of the brain.
 Correct
 Feedback

 General      The limbic system is the emotional center of the brain.
 Incorrect

MO                                        97 of 105
Screen Number        1.
 Feedback

 Question 8   The inability to easily make math computations may indicate problems with what
              brain area?

 Answer                       Answer Choices                            Specific Feedback
 Choices
                         (Bold the correct response)
 and
 Specific
 Feedback     Basal ganglia

              Left hemisphere of the cerebrum

              Limbic system

              Primary motor area

 General      Left brain functioning typically deals with linear computations such as math.
 Correct
 Feedback

 General      Left brain functioning typically deals with linear computations such as math.
 Incorrect
 Feedback

 Question 9   Which of the following drugs is a central nervous system depressant?

 Answer                       Answer Choices                            Specific Feedback
 Choices
                         (Bold the correct response)
 and
 Specific
              Cocaine
 Feedback
              Caffeine

              Alcohol

              Amphetamines

 General      Alcohol is a depressant and the rest are stimulants.
 Correct
 Feedback

 General      Alcohol is a depressant and the rest are stimulants.
 Incorrect
 Feedback

 Question     Which brain area functions to regulate and coordinate movement?
 10

 Answer                       Answer Choices                            Specific Feedback
 Choices
                         (Bold the correct response)
 and
 Specific
 Feedback     Midbrain

              Pons

MO                                        98 of 105
Screen Number       1.

             Cerebellum

             Medulla oblongata

 General     Coordination of movement is a function of the cerebellum.
 Correct
 Feedback

 General     Coordination of movement is a function of the cerebellum.
 Incorrect
 Feedback

 Question    Pleasure states experienced during massage that support mind-body health are
 11          processed in what area of the diencephalon?

 Answer                     Answer Choices                             Specific Feedback
 Choices
                        (Bold the correct response)
 and
 Specific
 Feedback    Thalamus

             Pineal body

             Meninges

             Midbrain

 General     The thalamus and hypothalamus are parts of the diencephalon.
 Correct
 Feedback

 General     The thalamus and hypothalamus are parts of the diencephalon.
 Incorrect
 Feedback


 Question    A massage application travels from the soft tissue to the brain on what part of the
 12          spinal cord?

 Answer                     Answer Choices                             Specific Feedback
 Choices
                        (Bold the correct response)
 and
 Specific
 Feedback    Cerebellum

             Pons

             Motor descending tracts

             Sensory ascending tracts

 General     Massage stimulates sensory receptors, and the signals are carried on the ascending
 Correct     tracts in the spinal cord.
 Feedback

 General     Massage stimulates sensory receptors, and the signals are carried on the ascending
MO                                       99 of 105
Screen Number        1.
 Incorrect   tracts in the spinal cord.
 Feedback

 Question    The protective membrane that is the is closest to the skull is the:
 13

 Answer                      Answer Choices                             Specific Feedback
 Choices
                      (Bold the correct response)
 and
 Specific
 Feedback    Dura mater

             Arachnoid mater

             Epidural mater

             Pia mater

 General     The dura mater is the thick protective covering found between the inside of the skull
 Correct     and the brain.
 Feedback

 General     The dura mater is the thick protective covering found between the inside of the skull
 Incorrect   and the brain.
 Feedback

 Question    Which of the following is most involved in pain modulation?
 14

 Answer                      Answer Choices                             Specific Feedback
 Choices
                      (Bold the correct response)
 and
 Specific
 Feedback    Histamine

             Dopamine

             Acetylcholine

             Endorphins

 General     Endorphins are the body‘s opiates.
 Correct
 Feedback

 General     Endorphins are the body‘s opiates.
 Incorrect
 Feedback
             A person is clumsy and has a dull or foggy mind in terms of understanding
 Question
             information and making decisions. Which of the following neurotransmitters may be
 15
             involved?
 Answer                      Answer Choices                             Specific Feedback
 Choices
                      (Bold the correct response)
 and


MO                                        100 of 105
Screen Number            1.
 Specific
             Norepinephrine
 Feedback
             Histamine

             Glutamate

             Dopamine

 General     Dopamine is involves in muscle coordination and the ability to concentrate.
 Correct
 Feedback

 General     Dopamine is involves in muscle coordination and the ability to concentrate.
 Incorrect
 Feedback

 Question    A client reports before the massage that his mind is agitated. He feels like he wants
 16          to scream. He is talking loudly and pacing. After the massage, he feels calmer and
             wants a nap. Which neurotransmitter is largely responsible for the mood change?

 Answer                        Answer Choices                         Specific Feedback
 Choices
                          (Bold the correct response)
 and
 Specific
 Feedback    Norephinephrine

             Dopamine

             Serotonin

             Substance P

 General     Serotonin is an inhibitory neurotransmitter.
 Correct
 Feedback

 General     Serotonin is an inhibitory neurotransmitter.
 Incorrect
 Feedback

 Question    Research indicates that massage increases the availability of the neurotransmitters
 17          serotonin and dopamine. Which central nervous system disorder would most benefit
             from massage?

 Answer                       Answer Choices                         Specific Feedback
 Choices
                         (Bold the correct response)
 and
 Specific
 Feedback       Stroke

             Cerebral palsy

             Parkinson’s disease

             Concussion

MO                                         101 of 105
Screen Number       1.

 General     Dopamine deficiency is related to Parkinson‘s disease.
 Correct
 Feedback

 General     Dopamine deficiency is related to Parkinson‘s disease.
 Incorrect
 Feedback

 Question    A client has a spinal cord injury resulting in the loss of use of her limbs. Which of the
 18          following is the most correct statement?

 Answer                   Answer Choices                               Specific Feedback
 Choices
                    (Bold the correct response)
 and
 Specific
 Feedback    The client has monoplegia.

             The client has paraplegia.

             The client has quadriplegia.

             The client has amyotrophic lateral
             sclerosis.

 General     ―Quad‖ means four and ―plegia‖ means inability to move. All four limbs are affected in
 Correct     quadriplegia.
 Feedback

 General     ―Quad‖ means four and ―plegia‖ means inability to move. All four limbs are affected in
 Incorrect   quadriplegia.
 Feedback

 Question    A client fell and sustained a head injury. The client was a bit confused at the time
 19          and the next day had a headache. Which of the following is the most accurate
             description of the client‘s condition?

 Answer                   Answer Choices                               Specific Feedback
 Choices
                    (Bold the correct response)
 and
 Specific
 Feedback    An aneurysm

             A severe contusion

             A transient ischemic attack

             A mild concussion

 General     The symptoms describe a concussion.
 Correct
 Feedback

 General     The symptoms describe a concussion.
 Incorrect
 Feedback

MO                                        102 of 105
Screen Number       1.

 Question    Which of the following CNS pathologies involves an interruption of blood flow to the
 20          brain?

 Answer                     Answer Choices                           Specific Feedback
 Choices
                    (Bold the correct response)
 and
 Specific
 Feedback    An infection

             A contusion

             A transient ischemic attack

             A concussion

 General     A transient ischemic attack is sometimes called a stroke and causes damage to the
 Correct     brain from lack of blood.
 Feedback

 General     A transient ischemic attack is sometimes called a stroke and causes damage to the
 Incorrect   brain from lack of blood.
 Feedback

 Question    Severe, recurring headaches that usually affect only one side of the head are called
 21          a:

 Answer                     Answer Choices                           Specific Feedback
 Choices
                    (Bold the correct response)
 and
 Specific
 Feedback    Migraine

             Seizure

             Epilepsy

             Tension

 General     A migraine is a vascular headache that is severe and can be debilitating.
 Correct
 Feedback

 General     A migraine is a vascular headache that is severe and can be debilitating.
 Incorrect
 Feedback

 Question    The fluid that surrounds and cushions the brain is called:
 22

 Answer                     Answer Choices                           Specific Feedback
 Choices
                    (Bold the correct response)
 and
 Specific
             Ventrical



MO                                      103 of 105
Screen Number         1.
 Feedback
             Sulcus

             CS fluid

             Plasma

 General     CSF, or cerebral spinal fluid, surrounds the brain and spinal cord.
 Correct
 Feedback

 General     CSF, or cerebral spinal fluid, surrounds the brain and spinal cord.
 Incorrect
 Feedback

 Question    The three parts of a neuron are the dendrites, cell body, and:
 23

 Answer                     Answer Choices                            Specific Feedback
 Choices
                      (Bold the correct response)
 and
 Specific
 Feedback    Frontal lobe

             Axon

             Descending tract

             Synapse

 General     The axon is the long extension of a neuron.
 Correct
 Feedback

 General     The axon is the long extension of a neuron.
 Incorrect
 Feedback

 Question    The arterial supply of blood to the brain is a branching network of vessels that is
 24          highly interconnected to ensure blood supply to the cells. Which of the following
             insures blood supply to the brain?

 Answer                     Answer Choices                            Specific Feedback
 Choices
                      (Bold the correct response)
 and
 Specific
 Feedback    Ventricles

             Cortex

             Circle of Willis

             Meninges

 General     The interconnected arteries at the base of the brain are called the Circle of Willis.
 Correct

MO                                      104 of 105
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    General       The interconnected arteries at the base of the brain are called the Circle of Willis.
    Incorrect
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    Question      Which of the following is most contraindicated for massage in the acute phase?
    25

    Answer                     Answer Choices                              Specific Feedback
    Choices
                         (Bold the correct response)
    and
    Specific
    Feedback      Dementia

                  Meningitis

                  Parkinson‘s disease

                  Alzheimer‘s disease

    General       Meningitis is an infection that would be a contraindication for massage.
    Correct
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    General       Meningitis is an infection that would be a contraindication for massage.
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    Engineering
    Notes




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Engineering
Notes




MO                                           105 of 105

				
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