hello everybody and welcome to our neurologic disorders this is part one and our topic today is disorders of the neurologic system here are the objectives and outcomes as well as the outline and before we talk about the neurologic disorders we've got to first talk about a basic concept of the neurologic system something that you have to think about whenever there is a neurologic disorder and when I like to think of our head as a box a very hard bony box because our skull is not like cardboard where there's a little stretch and a little give if we want to overstuff it no it's very rigid there is no ability for us to overstuff things in our head and what am I when I say things what am I talking about what's inside that bony skull well there are three main things that are inside our bony skull and that is the brain the blood and the CSF and if you look at it either in my little square box or in this pie chart you notice that each item the brain the blood and the CSF is allotted a specific amount of space and these items the brain the blood and the CSF must always stay within their allotted amount of space because if one item takes up more space then that's going to cause that crowning effect and because of that skull there's no give there's no stretch to it that's going to cause a problem for the patient now because our skull is a closed box again a rigid box that's closed there's not any opening or gaps within it this will cause the creation of pressure inside the head and this is known as intracranial pressure so again we have our bony box of the skull inside the skull we have the brain the blood the CSF each of these three items must make take up or have keep their allotted amount of space and because of these three items that are contained within this Pony box they do create a pressure and that pressure inside the head is known as the intracranial pressure now the other concept that's super important for you to understand is that there must be a balance between the intracranial pressure and the ability of blood to get up and into the head and so we call this balancing it's actually a mathematical equation we call this the cerebral perfusion pressure now to my mind when we say pressure well that comes to think about some Physics kind of thing and it's too complicated to think about so don't think of it as pressure I want you to think of it as perfusion oxygenation we learned in cardiovascular section that when we talk about perfusion we're really talking about the ability of the cells of the brain to get oxygen and cells of the brain must have a very steady state of oxygen so again what the principle you need to keep is the brain or the skull has three items the brain the blood and the CSF those three items create a pressure known as the intracranial pressure and the intracranial pressure must remain in a good balance to ensure that perfusion or oxygenation of the brain cells is always constant because the brain cannot survive or do very well without oxygen now what would cause a change in the intracranial pressure well a change in the intracranial pressure is going to occur when the brain the blood or the CSF take up more of their allotted space so what could cause the brain to get bigger or take up more space well things that cause cerebral edema or brain tissue edema such as a head injury or a brain attack because of a lack of oxygen a brain tumor means that there's this group of cells that is grown which we didn't need and so that group of cells is taking up more space it's taking up space that we don't need that to sell stressors we know that infections cause inflammation I say inflammation you say leaking which leads to cerebral edema so when you think about all of these things or any of these things rather any of these things can create more space occupying by the brain or perhaps blood vessels and therefore that will cause the increase in the intracranial pressure now we don't have that balance anymore and with an increasing in increasing intracranial pressure that can then lead to a lap or a decrease in the cerebral perfusion and again think of that cerebral perfusion it's oxygenation to the brain cell you try and hold your breath for four minutes see how well you do that's what's happening to that brain cell when there is less O2 available the brain cell will not do well has to have a steady state of oxygen and any rise in an increase in intracranial pressure is going to therefore decrease cerebral perfusion slash oxygenation all right now let's talk about the disorders and we're going to begin with probably the most common disorder that we think of within the neurologic system and that's a brain attack what is it well we Define the Brain Attack as the process of any Interruption of blood supply we're talking about arterial blood supply to a part or entire brain this is going to cause damage ischemia slash necrosis or infarction rather I'm sorry that's the wrong term infarction of the brain tissue now brain tissue or brain attacks were often called Strokes or cvas but essentially what the American Heart Wants To Do Is is ensure that the public the lay public who's not Health Care minded that they recognize that this is a true emergency and if there is a suspicion of a brain attack well you need to access the 9-1-1 and get in quickly now what are the causes or etiologies of a brain attack well there are several different etiologies but we're going to really break it down into its big part and that's atherosclerosis of either the cerebral arteries these are the arteries the many many arteries that feed the brain itself or it could be atherosclerosis of those incoming arteries that then feed the cerebral arteries so the incoming arteries of the carotids and the vertebral hypertension is also a cause of a brain attack and then there are some other kind of miscellaneous problems brain aneurysms and the link with heart problem is again there needs to be a steady supply of the cardiac output the brain is very greedy it takes about 25 percent of each time the heart or the heart to the left ventricle ejects blood and so it's very greedy organ it needs a lot of blood and so it has to have a steady supply to be able to function well again because we talked about the fact that causes really centered around the atherosclerotic process well now we go back to really what you know already from the cardiovascular system that lifestyle choices that lead to fatty deposits and the stiffening of the artery in other words any artery that becomes very stiff or non-stretchy or non-compliant can lead to hypertension and then you add the fact that the fatty deposits also lead to the stiffening of all arteries and now you have a great risk for a brain attack now of course the stiffening or arterial sclerosis does happen as we age you know if you think of a party balloon as that is a blood vessel we'll keep it for 70 years and blow it up every day all day long 70 times a minute and see how weak that rubbery gets as you stretch and stretch and stretch family history plays a role as well as diabetes is a big big and what do I mean when I say diabetes is a big risk factor I mean hyperglycemia because it's not necessarily just the presence of diabetes it's The Chronic hyperglycemia that leads to our stroke risk and then of course smoking is the evil always now there are two main categories of a brain attack ischemic brain attack and hemorrhagic brain attack and no matter what the cause whether it's ischemic or hemorrhagic the end result is that there is cerebral edema which then causes an increase that's I ICP an increase in the intracranial pressure now let's say you have a patient who presents with signs and symptoms of a stroke well I think it's important for you to understand that you cannot determine what kind of stroke it is whether it's a hemorrhagic or an ischemic stroke simply from the signs and symptoms that are presented or talked or told to you by the family or the patient we really have to take a look in the head and so I want to relay to you that the CT scan is super important it's one of the first things that's done whenever a person presents to their health care provider with signs and symptoms of a stroke we have to be able to identify what's the cause and we've identified that it's going to be either a hemorrhagic or an ischemic in its big categories all right we're going to talk about each one of those two categories we're going to talk ischemic first because it represents the bulk of brain attacks now what is it well it's caused by narrowing or blockage of the artery that supplies the brain so it can be the bigger arteries the main highways carotid or vertebral or it can be the smaller little roadways that are the intracranial arteries and we know again about the atherosclerosis and again the words are right there on your lecture notes but let's play our little artsy game and talk about um some picture forms because I know many of you are visuals so when we look here first we see that this is meant to represent the green squares or the brain cells and we see that of course there's blood vessels that flow and deliver oxygenated blood to each of these brain cells and there's lots of little bitty blood vessels now these blood vessels are anywhere from one to two millimeters get your ruler out these are small and again this Brown Line thing is meant to represent the nerve that is always weaving throughout the brain itself and if we have this plaque accumulation Within These itty-bitty arteries well then that's like a major roadblock in our path of the blood flow to these cells and once there is a cessation or a stoppage of blood flow now these cells become hypoxic and I want you to go back to module one if you don't remember this but we know that as soon as cells become hypoxic then they can't make ATP and that ultimately causes cell membrane disruption from edema now remember that we got the Bony box and so we don't have a lot of space in here and so when this cell that's supposed to be uh occupying a small amount of space gets bigger bigger bigger and a lot of other cells around it do too well these cells that create this or become a demetis are now going to cause more problems for their neighbors because they're going to extend into their neighbor space and just edema is going to beget problems with perfusion in the neighboring cells as well so it's kind of a cycle that never ends as long as this blood vessel remains blocked now what is the reason for the ischemic stroke well we know that there's a block in there somewhere and the block can be thrombotic in other words that plaque that's in that small artery in the neighborhood is the cause of it or it can be embolic in other words there could have been a plaque or some other item that came from a distant site now let me give you an example of an embolic event because we did talk about this in the cardiovascular disorder section and we know that atrial fibrillation is essentially when the Atria are equivalent like a bowl of jello blood is not moving forward and therefore because the blood is kind of static or there is stasis of the blood then clots can form blood is supposed to move and when it doesn't a clot can form that clock can break free and then of course you can see if it's in the left atrium very very quickly it can go up those carotids and therefore cause a problem in the brain look at that five-fold increase risk for a stroke in an individual with afib versus someone who doesn't have AFib there are some other miscellaneous causes for an embolic thrombotic stroke atherosclerosis of those carotids um air emboli clocks around the valves that can break off and then go if the valves become infected or they just age intracranial artery plaques so you know all of these essentially can create roadblocks in those very small little road Pathways where that are delivering oxygen to the brain now we're going to take a little sidebar here and talk about a transient ischemic attack now I want you to think of the highway you know there's times when stuff gets blown off vehicles and it creates a roadblock and then the wind kind of blows it and it gets out of the way well it's the same thing that can happen in the body you can have a roadblock or an emboli or thrombotic issue where that artery becomes block but then it doesn't stay blocked the body is able to kind of overcome the blockage and either push the thing away or dissolve it and it's a temporary thing the body is able to resolve it so by definition so this is the important piece your transient ischemic attack are something that happens transient in other words temporary so the signs and symptoms would be present for less than 24 hours they would last anywhere between 10 minutes to 24 hours and there would be no lasting neurological deficit in other words the cells recover and there's no infarction per se now I want you to think about this from the standpoint of your patient if an individual has a transient ischemic attack it is truly a warning sign you know what the lifestyle choices that you're making are really placing you at risk and if you don't make some changes one of these days you're not going to have a transient you're going to have a real full bloat fully involved stroke I know that that it always boils down to well tell me about the test you know how am I going to know about a TIA so your clue for the test is that you know if something has happened and the symptoms resolve and so you're told in the exam question that the symptoms have resolved and that the patient is doing okay symptoms went away then that's when you think of transient ischemic attack all right let's talk about the other type of brain attack and that's a hemorrhagic brain attack now of course the patho is a little bit different the hemorrhagic stroke is caused by the effects of blood that leaks out so here we have our blood vessel right here oh and I'm going to just go ahead and go straight to the picture here so here we have again this is our normal where we have nerves blood vessels and our green squares and heart are the brain cells and so here we have our blood vessel that becomes weakened that becomes weakened and you could say and lay people talk that it pops where it becomes disruptive or there's a tear in it however you want to say it but there is a leak of blood from within the blood vessel now out onto the brain cells because normally blood never touches the brain cells it flows around it in the blood vessels and things are diffused and move from blood into the tissue but blood doesn't ever actually touch the cell itself and so because or when there is bleeding from the blood vessel or a leakage of blood from the blood vessel onto brain cells this causes the frown face and by frown face I mean it causes inflammation I say inflammation and you say leakage so of course blood on brain cells is going to cause swelling cerebral edema brain cells are going to take up more space than they're allotted they're going to infringe on those cells in the area that aren't necessarily impacted by the blood which then once they crowd the other cells that causes cellular ischemia for those cells and so on and so on and so that's where we have our symptoms and again remember that nerve is there and so anything that occurs to the cells as far as cerebral edema goes it's going to also cause an impact on the nerve's ability to function too so again cerebral edema is problematic as it raises the intracranial pressure and then further decreases perfusion or oxygenation delivery to cells in the neighboring area that weren't necessarily impacted all right what are the causes of hemorrhagic Strokes well look at the big one pressure of hypertension take that balloon again take that party balloon and I bet it wouldn't even last 50 years if you blew it up very very hard with a lot of force um that wall is going to weaken the rubber on your balloon as well as the wall of the artery is going to weaken weaken weaken and it is going to cause a hemorrhagic Brain Attack the walls can become weakened from atherosclerosis aneurysms again these are a ballooning out of weakened arterial walls this could happen to lots of individuals not necessarily with high blood pressure they can occur with high blood pressure but some individuals develop aneurysms for London reasons congenital vascular malformations what are these well it's when the blood vessel is abnormally made and so these makes these blood vessels very weak which causes them to also leak bleeding into a tumor we go back to module one where we learned about angiogenesis arteriogenesis you know it's great that blood vessels are created not so much with tumors or cancers but you know in other good situations but no matter what arteriogenesis angiogenesis those blood vessels are um itty-bitty they're not very strong and they do they do break very easily and then there's coagulation disorders well of course somebody that can have hemophilia that's an easy bleeding person can have bleeding in the brain if perhaps they fall probably the most common scenario that you're likely to see that I have seen over my 41 years at the bedside many many times and that's the individual who had atrial fibrillation they don't want to have a stroke and so the physician puts them on a blood thinner so that they don't throw blood clots and then let's say the individual decides that they're going to clean a corner of the ceiling where there's a cobweb and they get up on a ladder and then they fall and hit their head and this can then cause a hemorrhagic stroke so not a good scenario but often can happen sadly right now let's move on and into I've talked a lot about the signs and symptoms of a brain attack as far as you expect to see them but what are they and we know that the brain is very complex we're going to keep it simple in our course the signs and symptoms are greatly going to depend on which blood vessel is affected because it is what that blood vessel supplies blood to that will really tell us where are the signs and symptoms and we're going to keep it simple again we're going to divide the brain into its hemispheres there's two of them right and left and then we have the cerebellar region and then we have the brain stem and that's all we're going to address there's other areas and again if you want to ever go to medical school or become a nurse practitioner you're going to have to learn the nitty-gritty details this is just a reminder of amp about the blood vessels I will mention them uh you're not going to be asked about which blood vessel supplies which portion that's your a p job but just be aware that any kind of disorder disease thrombotic embolic hemorrhagic can occur in any of the blood vessels you know as a nurse to determine where or what part of the brain is being affected by the brain attacked most nurses will deploy or use a very specific and organized assessment mannerism or mechanism and so that's what we're going to do in our course and we've got a mini concept of how about a blessing your patient again assessment examination these items mean the same thing so when we look at how we're going to go about we're going to first assess the autonomic system or status which includes level of Consciousness then we're going to send we're going to assess the sensory motor system which we will divide into two parts sensory motor above and sensory motor below the shoulders and then we're going to talk about the reflexes so let's first go to autonomic findings assessment what are we doing well when we talk about the autonomic status we're talking about those involuntarily controlled neurologic functions we're talking about our Vital Signs and when we talk about Vital Signs Vital Signs encompasses blood pressure management measurement heart rate measurement respiratory rate measurement and the measurement of the temperature and if any of these things are abnormal in the presence of a known intracranial problem in other words you suspect some kind of neurologic disorder then you measure your Vital Signs and you've got all these wacky vital signs your thoughts should go to the brain stem is where the problem might be located because it is in the brain stem where these autonomic systems or things are managed so again difficulty or abnormalities with any of the vital signs part of the autonomic status that occurs involuntarily are going to relate to a problem within the brain stem the other thing you're going to assess is the level of Consciousness and we often abbreviated it with loc and this refers to the brain's ability to respond appropriately now I want you to Circle this because changes in the level of Consciousness are often the first sign of a neurologic event or that something is worsening in a patient with an existing neurologic event so this is very important perhaps you've had some kind of head injury from a sports accident well and you were either not unconscious or a suspicion of losing Consciousness well again your family has to watch you they're going to ask you tell me your name do you know where you are what's the date who's the president and these are being alert and oriented when you can answer them appropriately is to self-time place and events so then that perhaps is measured or reviewed every two hours and so you have a patient who has a suspicion of a brain attack you assess for their levels of consciousness you find them to be awake and with it they talk to you well they follow your commands and then when you go back and you look at them two hours later now there's a big change in other words when you try uh or when you speak they don't open their eyes and respond to you and it's not only when you speak but when you touch them when you shake them that's also when they don't respond to you and so always this represents some kind of worsening neurologic event and of course it's usually related to cerebral edema which is causing increased intracranial pressure now when there is a change in the level of Consciousness you cannot pinpoint it to one specific area because level of Consciousness is truly kind of scattered throughout different parts of the brain you don't have to know this part and so this just helps you in general to identify that it's perhaps a worsening neurologic event but you're not going to be able to determine where the problem is or what part is worsening all right let's move to the second thing or the second part of our assessment and that's the sensory motor findings when we talk about sensory motor it's a term that means that movement and sensation are really tied together they're interrelated and what are we looking for where we're going to look for sensation and movement that is symmetric in other words it's equal bilaterally on the right and the left side of your patient now let's get into this kind of the subheading of sensory motor because we're going to divide it into sensory motor finding above the shoulders and below the shoulders so we're going to start with above the shoulders why do we divide it well because different parts of the nervous system rule the different parts of our sensory motor system and above the shoulders sensory motor function is ruled by those 12 cranial nerves now I should say 12 pairs of cranial nerves and they essentially Branch out from the brain stem and so we know that they are responsible for a great many functions above the shoulder and some below the shoulder but a lot above the shoulder now you you probably have learned all 12 pairs of cranial nerves you don't have to know that for patho you do have to know three of them and that's cranial nerve two three and seven now as we talk about the sensory motor function of each of these cranial nerves what I want you to identify is that when you assess your patients if these cranial nerve function or the cranial nerves that these nerves rule it's okay then we know all right the nerves are okay and that portion of the brain is probably okay too in other words there's no injury or edema to that specific part now we're going to talk first about abnormalities of the cranial nerve seven this is the facial nerve what does it do well it controls facial movement and expression and if there is a focal lesion and by that I mean let's say there's let's look at this black dot here where the cranial nerve seven is if there is cerebral edema or tumor or bleeding right there will that cranial nerve Wiggles and moves through the brain then and especially if that cranial nerve is coming out of the right hemisphere we can expect to find asymmetric findings in other words unequal unequal findings on the opposite or contralateral side what do I mean by that so if there is focal cerebral edema around the right hemispheric cranial nerve that allows for a smile you would expect to see facial drooping on the left side of the mouth so let's look at that so when we look at this guy now remember you're looking at him so we're going to have to go it's a mirror image so we said here's his right side we said that if there's cerebral edema around the right hemispheric cranial nerve seven that controls facial movement then we are going to see facial drooping on the left side of our patient's face so you can see how the mouth dips down he's not able to fully close his lips that's drool that's um dripping out or saliva you can see how his eyelids are drooping and even on his forehead you can see how the eyebrows are really drooping down now I do want to make sure that you understand terms we say contralateral all the time that's the opposite but ipsilateral means equal and that is really because you know on tests we're always testing you to make sure and there's really nothing that's ipsilateral in this neurologic system everything's contralateral so don't pick anything with ipsilateral that means same side contralateral and that concludes your medical terminology for the moment all right let's look at cranial nerve 2. cranial nerve 2 is the optic nerve it's responsible for transmitting visual images to the brain and so if there is a focal cerebral edema in the right cranial nerve two that should be transmitting visual images to the brain you would expect that there would be visual deficits or defects in the two left halves of both eyes and this has a name Anonymous homonopia and here's what it looks like so let's look at this because again uh this time it's not a mirror image it's what would be seen by the patient so I want you to pretend that you're looking outside your window and with both your eyes and this here on the left on your left is the left eye this is the right eye and the left visual field so in other words on the left eye this is the visual field of the left side of the left eye and this is the visual field of the left side of the right eye there is going to be no image the only side that this patient can visually see is the right half of the right side of both eyes so again when your patients say and they're not going to necessarily be able to identify this is homonymous monopia they're going to say something's wrong with my vision I can't see things very well and so you the nurse are then going to have you're going to have to assess and um and test them on this which we won't address in this course you'll learn about that later in nursing so again right cranial nerve to that transmit visual image if there is a defect cerebral edema around the right cranial nerve too the left halves of both eyes are going to have visual defects and this is known as homonymous homoniopia all right now we're going to talk about the pupillary right light reflex the pupillary light reflex which cranial nerves are responsible for that well cranial nerve two the optic nerve and cranial nerve three the oculomotor nerve controls the pupillary light reflex when there is normal function both pupils should respond equally to light in other words if I shine shine shunt put a light on an eye then we know that your pupil will constrict they should constrict in both eyes to the same size so they should be equal bilateral and when there is a bilateral loss of the pupillary light reflex both pupils will either in other words both pupils either fixed and dilated or fixed in pinpoint this will indicate a brain stem lesion now if you're a paramedic or you have some experience in health care you might say oh well what about some other odd eye pupil changes we're not going there in this course we're going to keep it simple and so what I want you to know that cranial nerve two and three are all about the pupillary light reflex if there is fixed and dilated or fixed and pinpoint or constricted pupils then use a nurse know that this is a brain stem problem all right now we have completed that sensory motor assessment above the shoulder and now let's talk about what would we do what would we see with the sensory motor below the shoulder so before we talk about what we would see we got to discuss the ANP review so what controls the sensory motor function below the shoulder and that is two things the cortical spinal tract and the spinal thalamic track now corticospinal tract is our nerve function that starts in the brain and then moves down into the periphery we often call it or it's often called the pyramidal tract so it starts in the motor cortex and there's a right and a left parameter pyramidal or corticostinal tract now how does it function well let's pretend that we have we're talking about the left corticospinal or pyramidal tract so we see that it will whenever there's a nervous innervation or or uh stimulus we see that it moves down through the brain and then in this area part of the brain there is this pyramid looking cells where the impulse crosses over which is known as decasate and therefore it will then cause a motor response on the opposite side so the contralateral side so if it that means that the left pyramidal tract controls the right side of the body now conversely spinal thalassic spinothalamic tracts carry sensation pain temperature crude and light touch from the body so out from the periphery up to the brain and spinal thalamic tracks also cross over and we're not really going to address much information about that what you need to know is that it's always contralateral rules so wherever it is whether it's spinal thalamic or corticospinal pyramidal function it's the right side controls the left periphery and left and and left brain controls the right now let's put it all together and let's say that you've decided to put your finger your index finger on a heat source so how's it going to work well your heat sensors in the spinal thyllabic tracks are going to move from your finger up your arms to the spinal cord up the spinal cord cross over and move to the left side of the body so the right index finger sensation of pain and heat is going to be sensed or recognized interpreted by the Lux spot or the left side and then the corticospinal parameter track will then send the message move your finger uh from the left cortex down cross over or decasate and then that's how you move and you know that this happens almost instantaneous so this is a very efficient nervous system that moves these messages very very quickly now let's really get to what you have to know in the course and that's if there's a focal lesion that's related to the corticospinal tract then we know that asymmetric sensory motor assessment will be found so we know that if a patient had a tumor on the right side of the brain they would likely have decreased strength movement and ability to function on the left side of the body below the shoulders so that's your key right side of the brain affected that will cause the pyramidal dysfunction or pyramidal tract dysfunction and you will have left-sided asymmetric changes now let's talk about the last thing that we assess we want to assess the reflex findings well we divide reflexes into two main categories and that's peripheral and Central and we talk about peripheral reflexes um these are really about Connections In The Reflex arcs in the spine and normal interpretation in the brain and so this is a picture of the patellar reflex someone hits the knee there and then the leg just has a reflex and it's a kind of a in a reflex arc involuntary you don't have to think about it it just happens now that is very different than the central reflexes Central reflexes are those that are ruled by the cranial nerves cranial nerves rule our cough swallow gag blink and so if there is any kind of brain lesion yes our deep tendon reflexes can become abnormal hyper reactive all right but it is what we truly do care a lot about when there is a central reflex that is inadequate because we know that from module 2 where we're from our mechanisms of Defense where we discussed that it is so important to have a properly working gag swallow blink and cough reflex in our protection against things happening such as food going into our lungs instead of down into our gullet so this is a very important concept for you the nurse because you absolutely must assess for a gag a swallow and a cough reflex whenever your patient has signs and symptoms of an intracranial problem because you definitely wouldn't want to give them food or water because you put them at harm if they lack or have an any deep efficient or hyper reactive reflex of gag swallow and cough whoops kind of went over and above all right now there are times when reflexes become inappropriate in other words they don't respond the way they should and one such example that we're going to address in the course is the Babinski reflex which is also known in the plantar reflex now what is it well you can see from this picture that you take into item that's not sharp but something that you can put a little bit of pressure and then you go from the heel and you move it around uh to the top underneath the toes and what you should see in every adult is that the toes all five of them will kind of curl down excuse me and they should curl down when you do this bilaterally in other words when you do the Babinski reflex on the right foot you should have it curl down and then when you do it on the left foot it should symmetrically or bilaterally be the same it should absolutely curl down now it is of note that if you have access to a child someone that is let's say nine months definitely less than two years do the Babinski reflex on a young young infant hopefully someone's infant that you know and do the Babinski reflex and you will see this Fanning out of the toes but in an adult if you see Fanning out then what it is then termed as a positive Babinski and this is abnormal in adults and that's what we deal with we address in our path of course adults only so again if we see a positive Babinski reflex in other words of Fanning out that we know there's something wrong with this reflex and therefore we would make sure that we do it on both feet because we want to determine is the reflex positive unilaterally in other words is it on one side or is it bilaterally on both sides because this is going to help us determine where the problem in our intracranial or neurologic system lies all right I think it's time for a break I hope this recording has been helpful I've put a link for a Normal and abnormal Babinski reflex if you want to see it for fun it's about a 54 second thing that you can watch and again I hope this has been helpful please email your instructor if you have any questions