we will discuss some clinical conditions or pathologies uh of nervous system in this section uh as we know that there is central nervous system and peripheral nervous system and the um the pathologies for the two are so different um for the central nervous system pathologies um the example that I have is some are um congenital like spinal bifida spinal bifida is basically the vertebra uh failed to close so that uh the CF CSF kind of go out of the the aspinal cord and uh depending on the level that would affect the level below um and also uh if it's too severe um some surgical procedure may need to be performed for the brand uh one example uh I I have is uh Hydro syphilis hydrus is we have uh too much amount of CSF um inside the brain that would turn out um to have enlarged ventricles uh because basically our brain is swollen right so uh that would affect all the brain functions that we have if the damage is again like uh at the spinal injury it can be uh some kind of um um externally um damage the spinal core or but whatever the mechanism is when there's a damage um to the spinal cord it would affect the level and below and depending on the severity of uh the injury some some people may have the complete damage like they lost sensory and motor function some may be incomplete that some may have some kind of preserved sensation or preserved motor function um it depend it really depends on uh what's left so a thorough evaluation is necessary and there are uh degenerative uh diseases like alss is basically the progressive uh uh degenerative motor disease so uh it's more like a motor fiber kind of thing um and also there is Ms Ms is basically the disease for uh the myin so uh for unknown reason the myin start to um um damage to be damaged so you can see it's a progressive in a way um so these are examples that I have for the central nervous system pathologist so now uh more often or more common uh we see a lot of peripheral nerve injuries but before I introduce you some examples for pns uh injuries I want to talk about how we classified these injuries so um in general we categorize in three so a neural praia basically the nerve is being gently stretched or compressed like we uh s on the table and we hit our Funny Bone we sense some kind of sensory uh um symptoms that numb tingling and when we shake when we shake our hand it goes away that's neuropraxia if it's more severe uh that would affect the axone then depending on the degrees of the the damage to the axo then um we will have different symptoms when the nerve is dead then it's neurom masses so basically we uh the nerve stop transmitting information so the nerve is dead so and the the prognosis uh when the nerve is dead it is dead so it it can be really hard this is one example just to show if it's a neuropraxia um recovery can be um um POS possible if it's axle masses depending on the degrees of um the the damage it can be the sheath sorry the uh the myin or if it's too severe that would um hurt the axone then it's too severe um and then neurom mass is basically the nerve the this SE segment of nerve is dead um current um way to categorize these uh nerve injury uh in addition to uh neuropraxia exom masses and neurom masses we uh you can see people refer it to uh one through five degrees of the nerve injury but in short in the beginning we we sense the sensory uh uh symptoms like numb tingling shooting pain whatever and then it gets worse and worse and worse that means we experience more severe uh sensory symptoms more worse and worse and starting when the axone is damaged we start to show some motor uh damage like weakness um of the muscle and then we start feeling anything we stop uh moving our our body segment because the nerve is dead so when we feel a little bit and then it gets worse worse worse and then we don't feel so that's that's how um clinically I interact with my client that they told me oh I stared to feel this and then I stopped feeling I was like okay so you need to do some nerve conduction test to make sure that the nerve is still alive right so why do we need to know all these though specifically uh for bracho plexus I mean it's so complicated right um because it it's so complicated so when it got hurt and the the uh representation or the symptoms uh or the area will be different and it's hard um to diagnose and that's why uh um often times when we had a correct diagnosis it's too late because nerve degenerate day by day or hour by hour or minute by minute so as a therapist we need to be sensitive to these kind of changes but first of all the symptoms for the bracho plexis injury is they feel pain they feel loss of sensation or impair of sensation and some motor weakness may happen um and the cause of frop plexis can be very different like it can be uh in a car accident or uh uh a a a trauma or a gunshot wound or stabbing or uh uh compression um occasionally um in my uh about um 28 years of practice um I got referral from a newborn baby because doing you know the mother laboring and uh the mewi or um the doctor is trying to help they pull the baby out and that's when they hurt uh the bracho plexus like I said it's hard to diagnose so it take time to do do it uh typically uh it require some kind of history and then some kind of EMG to understand um what is left and you know if the nerve is conducting okay um as a therapist we we can contribute by evaluating range of motion strength and sensation to really know um you know to monitor the progress of the uh um the nerve injury and these is just to um show you that the uh braul plexus can be misdiagnosis by all other conditions like near to the bracho plexis again um it's very rare that we have uh a brao plexus at Birth but it happened right and in general um when you um see the upper uh brecho plexus which is C5 through C8 or C7 maybe C7 um it it mostly affect the shoulder and a little bit of the elbow that's what what we call Herb py if it's the lower part of the brachio like C7 through T1 that's the lower part of the um the black Kill U plexus um that would affect more wrist and en hand function and we call it Plum Keys uh py this is one example of you know how um we use splint to uh position the nerve so it's in a shortening position so the nerve uh we don't offer too much tension to the nerve so the nerve can grow uh but it takes a long time on a ideal condition the nerve grow 1 mm per day and you see that from where it got injured and it had to regrow all the way to the end of the limb it takes a very long time so rehab is really important so the goal for the rehab is to maintain the passive Ral motion um to uh offer education on what is proper uh positioning for our clients and there may be some kind of functional um impairment like you know it's very inconvenient to keep our hand in that position when we need to like dress we need to eat and all that so OT are really good or I can say the expert in educating and you know work with our client on how to um handle the life situations like this but most importantly we have to be patient and we have to encourage our clients like it's it's going to take some time okay so so this is the uh injury for the brachial uh plexus um the Turner syndrome is another or people call it winging uh winging scapula you can see that the scapula is kind of like a winging here and this is the injury for the long uh thoratic nerve and we know uh this uh nerve long thoratic nerve innovates uh the seratus anterior and serus anteriors is good to it's functioning to do um U scapular protraction right so without a function for uh seratus interior then the scapula is kind of like out of the place like this another example that I have for nerve injury is uh thoric ALC syndrome this is an area that is very complicated uh because it has muscle and it has has artery and it has nerve like they are all in this place so um it the symptoms May um May differ by the uh what tissue is being injured right and the symptoms if if it's purely for the nerve symptom so the symptom is very similar to all the nerve symptoms right like the sensation like the motor this kind of thing so uh the treatment for uh thoratic uh outlet syndrome it really needs a careful evaluation to understand what is the causing factor to it and then we um according to the factor that we identify then we we know how to uh treat uh this outlet syndrome