Cerebrospinal fluid (CSF) nourishes and protects the CNS. All are true about the flow of CSF system EXCEPT:

Formed by blood through filtration in the venous cavities

Dysesthesia

unpleasant sensation

Allodynia

innocucous stimuli causes pain

Paresthesia

unusual feeling

Occlusion of the middle cerebral artery and ischemia of the inferior parietofrontal lobes of the right hemisphere may result in which of the following?

• Impaired nonverbal communication
• Apraxia
• Hemispatial and hemipersonal neglect

Where is cerebrospinal fluid NOT normally found in the CNS?

Between the pia mater and the brain

I visited my grandma at her independent living facility. She is usually sharp as a tack, but today she was wet, wobbly, and wacky. She says that she is fine, but angry with herself. She mentioned that she tripped over a rug a week ago.

What condition is most likely associated with her symptoms?

A subdural hematoma

After a right radius/ulnar fracture, Sandra Bullock had surgery and therapy for 6 weeks. Six months later, she returns to Occupational Therapy. She still has continuous pain, cannot touch or be touched on the right arm, and feels her right hand always cold. You are her occupational therapist.

What is most likely be happening with her, and what should you do?

CRPS - focus on somatosensory rehab protocol

Lady Gaga released her last album Mayhem last week. She is fabulous despite the fibromyalgia. All of the following are true about fibromyalgia EXCEPT:

Pain comes from peripheral tissue damage.

fibromyalgia

• Pain can be caused by physical or emotional stress.
• It is often misdiagnosed as a mental health condition.
• Pain is described a constant dull pain.

When you stub your toe, you can localize the pain and move quickly away from it. Which of the following statements are TRUE about this pathway?

Fast pain signals are carried along the spinothalamic tract.

The pain matrix consists of neurological structures that process and regulate pain information.

Which of the following structures is part of the pain matrix?

Thalamus

A person may experience sensations that a limb is still present, despite amputation. This MOSTLY occurs because:

The somatosensory cortex remains intact

Where is cerebrospinal fluid normally found in the CNS?

• Subarachnoid space surrounding the brain and spinal cord
• In the ventricles in the brain
• In the central canal of the spinal cord

Rapid Fire: Fibromyalgia

Tell me how the following types of pain can be classified: Pain Matrix or Pain Syndrome?

pain matrix

Rapid Fire: Chronic Back Pain

Tell me the how the following types of pain can be classified: Pain Matrix or Pain Syndrome?

pain syndrome

Rapid Fire: Migraine

Tell me how the following types of pain can be classified: Pain Matrix or Pain Syndrome?

pain matrix

Rapid Fire: CRPS

Tell me how the following types of pain can be classified: Pain Matrix or Pain Syndrome?

pain syndrome

What is Pain as a Symptom and Pain as a Syndrome? Can you give an example?

• Pain as a symptom → headaches, toothaches, stomach cramps
• Pain as a syndrome → osteoarthritis, CRPS

Think about the Acute Pain Pathway
Where is the 2nd order located?

• dorsal horn

Jim, 48 y/o, has Parkinson Disease. Every time he walk too much in a day, he has severe pain on both of his hips.

• He doesn’t have any motivation to continue to exercise in the next day. Why?

• Pain-Induced Avoidance → Experiencing severe hip pain after walking may cause Jim to fear movement (kinesiophobia) and avoid physical activity.
• Fatigue & Motor Symptoms → Parkinson’s Disease (PD) can cause muscle rigidity, bradykinesia, and fatigue, making movement more challenging and discouraging.
• Dopamine Deficiency → PD reduces dopamine levels, which impacts motivation, reward processing, and effort perception, making exercise feel overwhelming or unrewarding.

Type of Pain

Jim, 48 y/o, has Parkinson Disease. Every time he walk too much in a day, he has severe pain on both of his hips.

• Describe the type of pain?

• Musculoskeletal Pain → Likely due to muscle stiffness, joint strain, and altered gait mechanics.
• Neuropathic Pain → Some PD patients experience nerve-related pain, contributing to discomfort beyond typical muscle soreness.
• Dystonic Pain → If related to involuntary muscle contractions (dystonia), it can worsen with exertion.

Jim, 48 y/o, has Parkinson Disease. Every time he walk too much in a day, he has severe pain on both of his hips.

• Describe the pathway of the pain.

1. Nociceptors (pain receptors in muscles & joints) detect inflammation or strain in the hips.
2. Peripheral nerves transmit signals to the spinal cord via the spinothalamic tract.
3. The thalamus processes the pain and relays it to the somatosensory cortex (pain perception) and limbic system (emotional response).
4. The brainstem & basal ganglia (affected by PD) may alter pain modulation, making pain more intense or prolonged.

Jim, 48 y/o, has Parkinson Disease. Every time he walk too much in a day, he has severe pain on both of his hips.

• How you, as an OT, would you do to assess and intervene?

• Assessment: Pain & Function Assessment: Use Visual Analog Scale (VAS) for pain levels and Parkinson’s Disease Questionnaire (PDQ-39) to assess mobility and quality of life.
• Intervention: Set realistic, meaningful movement goals (e.g., short walks to a favorite café).
  • Encourage social engagement during walks to enhance dopamine release and reduce apathy.
  • Pacing Strategies (shorter, frequent walks instead of one long session).

Sonia, who has diabetes for many years, has diminished sensation on the bottom of her feet.

What is happening with the nociceptors of her foot?

• diabetic peripheral neuropathy (DPN)
  • damage to peripheral nerves
  • reduced nociceptor sensitivity
  • impaired signal transmission

Theresa Caputo, the Long Island Medium, had a small surgery on her kidneys.

• After the surgery, she feels pain on her lower back. Why?

Refererd pain