musculoskeletal, neuroscience & clinical biochemistry...
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Musculoskeletal, Neuroscience & Clinical Biochemistry 1
Musculoskeletal, Neuroscience & Clinical Biochemistry 2
Head and Neck and
Neuroscience Module
Introduction
The nervous system facilitates, contact of an individual with his external and internal
environment and aids appropriate responses. Head and Neck and Neuroscience module
introduces the basic development, structure and function of the nervous system emphasizing
common neurological disorders.
The content areas include basic structure and function of important anatomical areas in head
and neck, the normal and abnormal development of the nervous system, organization of
human nervous system, control of movements, integration of different sensory modalities like
general sensations (pain, touch etc) and special sensations (vision, hearing) as well as higher
cerebral functions like speech and memory.
The above content areas are covered by lectures, dissections, practicals, tutorials and small
group discussions. Language lab activities are incorporated to improve the knowledge on
English language relevant for the module. To further enhance the knowledge on the subject,
IT lab activities have also been included. The activities during self study slots and student
seminars will further enhance student centered learning.
At the end of the module the students are expected to understand how the structure of the
nervous system is related to the functions. Finally we expect the students will use the
knowledge and skills acquired during this module to solve clinical problems in neurology.
This module will definitely be a good base for the phase II neuroscience module.
Good luck and all the best for you and hope you will enjoy learning this module!
Neuroscience module Committee.
Prof. Ranil De Silva(Chairperson, Department of Anatomy)
Dr. C.Hewage (Convener,Department of Physiology)
Dr. M.R.P.H. Liyanage
Dr. SitaraDissanayake
Dr. DineshaSudusinghe
Ms. L.V. Athiththan
Dr. U. Senarathna
Musculoskeletal, Neuroscience & Clinical Biochemistry 3
Overall aim
At the end of the neuroscience module the students should acquire basic knowledge on
development, structure and functions of the nervous system and should be able to identify
common disorders that affect the nervous system.
General Objectives
At the end of the Head and Neck and Neuroscience module, the student should be able to;
1. Describe the normal and abnormal development of CNS.
2. Describe the Structure of the head and neck region.
3. Describe common and special sensations and its clinical relevance.
4. Describe Anatomical and Physiological basis of motor system and its clinical relevance.
5. Discuss physiological basis of higher functions and disordered physiology.
Main Content Areas
• Structure of head and neck
• Embryology and organization of central nervous system.
• Sensory system.
• Motor system.
• Higher functions, Sleep and Hypothalamus
Musculoskeletal, Neuroscience & Clinical Biochemistry 4
1. Embryology of Head Neck and CNS
A-Essential to know B- Good to know C- Nice to know
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the development of the face and neck.
Describe the development of CNS
Development of head and neck
region, Pharyngeal arches and its
derivatives. (Endoderm, Mesoderm
and Ectoderm)
Development abnormalities of the
face (A)
Development of CNS and Pituitary
gland.
Development of brain stem
(Midbrain, Pons, and Medulla) and
nuclei and spinal cord. (A)
Embryological basis of
developmental abnormalities of the
CNS. (A)
Lecture
Lecture
SGD
2 hrs
1 hr
2 hrs
Anatomy
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 5
2. Structure of Head and Neck Region
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the osteology of the skull and cervical
vertebrae
Observe and identify the surface anatomy of the
neck
Discuss the boundaries, contents and
foreminae of anterior, middle and
posterior cranial fossae. (A)
Development and ossification of
skull and cervical vertebrae. (B)
Surface anatomy of the neck –
observation on swallowing and
palpation of hyoid bone, thyroid
cartilage (superior border), cricoid
cartilage. (A)
Thyroid gland (isthmus and lobes)
(A)
Palpation of one common carotid
artery against the carotid tubercle on
C6. (A)
Observation of the jugular veins on
straining and on lying down. (A)
Observation of each
sternocleidomastoid muscle when
contracted against resistance. (A)
Demonstration
and self
learning
SGD
Demonstration
and self
learning
3 hrs
2 hrs
2 hrs
Anatomy
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 6
3. Scalp, face and triangles of neck
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the scalp
Describe the gross anatomy of the face, temporal
fossa
Describe the anatomy of triangles of the neck
Describe the lymph drainage of the neck
Layers of the scalp with its
attachments and relevant clinical
features. (A)
Anatomy of face and temporal fossa
including its muscles, vessels and
nerves. (A)
Deep fascial layers and deeper
planes of the neck. (A)
Boundaries, contents of the triangles
of the neck. (A)
Cervical plexus. (B)
Lymphatic drainage of the neck
Lecture
Dissection /
demonstration
SGD
Dissection /
demonstration
Lecture
1 hr
2×3 hrs
2 hrs
3 hrs
1 hr
Anatomy
Anatomy
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 7
4. Thyroid gland
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the structural and functional anatomy and
the development of the thyroid gland.
Describe the anatomy of the parathyroid glands
Structure of the thyroid gland. (A)
The blood supply of the thyroid
gland. (A)
Relations of the thyroid gland. (A)
Structures which may compressed
by thyroid enlargement. (A)
Basis for the movement of the
thyroid swelling on swallowing .(A)
Perform a thyroid examination.
(B)
Functional anatomy of thyroid
(recall) (B)
Structure of the parathyroid gland.
(A)
Blood supply (A)
Reason for hypoparathyroidism after
thyroidectomy. (A)
Histology of parathyroid (recall)
(B)
Lecture
SGD
Dissection
Self Study
1 hr
2 hrs
3 hrs
Anatomy
Anatomy
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 8
5 .Larynx
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the structure function and relationships of
larynx
Define stridor
Structure of larynx. (A)
Blood supply and nerve supply of
larynx. (A)
Mechanisms of speech swallowing
and cough. (A)
Heimlich maneuver in choking. (A)
Laryngoscopic view of laryngeal
inlet. (labeled diagram) (A)
Causes / mechanisms of stridor in
laryngeal disorders. (A)
Surface mark / identify the site for
cricothyroid puncture. (A)
Surface mark / identify the site for
tracheostomy procedure. (A)
Cervical trachea relations. (A)
Lecture
Dissection,
demonstration
and prosected
specimens
SGD (combined
with pharynx
1 hr
3 hrs
2 hrs
Anatomy
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 9
6 Root of the neck
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the root of the neck
Scalene muscles
Attachment / relations (A)
Subclavian artery and branches (A)
First rib and relations (A)
Brachiocephalic trunk (A)
Thoracic duct – Origin and course
(A)
Suprapleural membrane (A)
Apex of the lung (A)
Brachial plexus roots. (A)
Vagus and phrenic nerves – course
(A)
Lecture
Dissection / self
study
(recall)
AVP
(recall)
(recall)
(recall)
1 hr
3 hrs
2 hours
Anatomy
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 10
7 Salivary glands
Intermediate Objectives Broad Content Areas Activity Duration Department
Macroscopic & microscopic anatomy of the
salivary glands and the duct system
Gross anatomy of the salivary
glands, Lymphatic derange, nerve
supply, blood supply, Duct system
(A)
Parotid gland ( Boundaries,
Contents, Parotid fascia, Position,
Parts and related structures) (A)
Submandibular gland ( Size and
shape, Parts, Relations) (A)
Sublingual gland. (B)
Microscopy of salivary glands (A)
Lecture
Dissections /
prosected
specimens
Histology
practical with
tongue
Recall
1 hr
3 hours
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 11
8 Deep spaces of neck and tempero-mandibular joint
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the deep spaces of the head and neck
Describe the Tempero mandibular joint.
Muscles of mastication
Masseter, temporalis, lateral and
medial pterygoid. (A)
Infra temporal region. (A)
Pterygopalatine fossa. (A)
Parapharyngeal space (A)
Retropharyngeal space (A)
Articular surfaces
Capsules and ligaments,
Sphenomandibular ligament
Articular discs
Movements of the tempero
mandibular joint (A)
Lecture
Dissection /
demonstration
Lecture
Demonstration
1 hr
2×3 hrs
1 hr
Anatomy
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 12
9 Mouth and tongue
Intermediate Objectives Broad Content Areas Activity Duration Department
Identify the structure of the mouth & its functions.
Describe the structure of the tongue.
Vestibule, lips, Cheeks, gum, teeth,
mouth. (A)
Palate (roof) – Hard palate, soft
palate, Muscles (Levator palatini,
tensor palatini, Palatoglossus,
palatopharyngeus) Vessels and
nerves. (A)
Floor of the mouth, boundaries,
contents (Submandibular gland,
Submandibular duct, Sublingual
gland, Lingual nerve, Submandibular
ganglion, Hypoglossal nerve) (A)
Structures palpable in the bimanual
examination of the mouth. (A)
Macroscopy & microscopy (A)
Blood supply (A)
Nerve supply (A)
Lymph drainage. (A)
Development. (A)
Lecture
Prosected
specimens
SGD (combined
with tongue)
Lecture
Prosected
specimens
SGD (combined
with mouth)
1 hr
3 hrs
2 hrs
1 hr
3 hrs
2 hrs
Anatomy
Anatomy
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 13
10 Pharynx and cervical part of oesophagus
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the structure of the pharyngeal wall
Describe the cervical part of Oesophagus
Muscles : External, Internal (A)
Nerves, Arteries, Veins,
Lymphatics(A)
Nasopharynx (walls, choanae,
Features: nasopharyngeal tonsils,
opening of auditory tubes, tubal
tonsils, salpingopharyngeal fold,
pharyngeal recess) (A)
Oropharynx (walls, palatoglossal &
palatopharyngeal arches, features:
palatine tonsils, intratonsilar cleft)
(A)
Laryngopharynx( walls, inlet of
larynx, features: medial & lateral
epiglottic folds, epiglottic
valleculae) Piriform recess (A)
Waldeyer’s ring (A)
Course and relations of cervical
oesophagus. (A)
Lecture
Dissections /
Prosected
specimens
SGD (combined
with tongue)
Dissections /
demonstration
1 hr
3 hrs
2 hrs
1 hr
Anatomy
Anatomy
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 14
11 Nose, paranasal sinuses and nasopharynx
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the structure of nose
Describe the structure of paranasal sinuses and
nasopharynx
General structure of external nose,
nasal cavity, septum and lateral wall
(A)
Vascular plexus in the nose (A)
Histology of nasal epithelium (A)
Structure of olfactory epithelium(A)
Anatomy of paranasal sinuses and
nasopharynx (A)
Functions of paranasal sinuses (A)
Explain the anatomical basis of
1. Epistaxis
2. Sinusitis
3. Reduced smell in nasal
problems
4. Reduced hearing in nasal
problems (A)
Structure of auditory tubes (B)
Lecture
Dissections /
demonstration
Lecture
1 hr
3 hrs
1 hour
Anatomy
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 15
12 Major vessels of neck
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the major vessels of the neck
Common carotid artery and External
carotid – course, relations and
branches. (A)
Internal carotid artery – course
(branches will be dealt with
neuroscience) (A)
Internal jugular vein and its
tributeries. (A)
Lecture
Dissection
1 hour
3 hours
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 16
Brain and related structures
4.0. Describe the meninges and
function.
4.1Basic arrangement of
ventricles of the brain.
Arrangement of meninges
Describe the CSF formation circulation and
absorption, normal composition and
functions.
Discuss normal intra cranial pressure (ICP).
List the causes of increased intracranial
pressure.
Anatomical basis of the presentations of
increased ICP.
Explain the nature of the Blood brain
barrier(BBB)Compounds which cross the
BBB.eg drugs
Describe the anatomical principal of
carrying out lumber puncture in adults and
neonates.
Intracranial hemorrhage (A)
Lecture
Lecture
2hrs
1hr
Anatomy
Physiology
5.0. Describe the blood supply of
the brain
And spinal cord.
Describe the arterial supply and venous
drainage of the brain and spinal cord. (A)
Lecture
Lec:demonstration
/AVP
Seminar
1hr
3hrs
Physiology /Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 17
6.0. Describe the arrangement of
the CNS
Identify and describe,
Basic components of brain
(Fore brain, mid brain, hind brain).
Describe the regions sulci and fissures of
the cerebral cortex.
Structure of the spinal cord, cross sections
of the spinal cord.
Ability to draw and describe cross section
of the brain stem. (A)
AVP
Dissection/
Demonstration
Lecture
3hrs
3hrs
2hrs
Anatomy
Anatomy
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 18
Cranial nerves
7.0. Describe the anatomical
pathways of cranial nerves with
functions and dysfunctions.
Cranial nerve i, ii, viii will be discussed under
sensory system.
Anatomical pathways of cranial nerves.
Functions of the 3rd 4th and 6th nerves. (A)
Discuss the nuclei arrangement function and
nerve distribution of the 5th nerve.
Discuss conditions which affect these nerves
and there clinical manifestation.Eg:herpes
zoster
Anatomical pathway of the 7th nerve and 7th
nerve palsy,
(LMN & UMN lesions of 7th nerve) (A)
Lecture on orbit
eyeball
and3rd,4th,6thcranial
nerves.
Model demonstration
SGD eyemovement
Lecture
Lecture
Tutorial
1hr
1hr
3hrs
1hr
1hr
2 hrs
Anatomy
Physiology
Anatomy
Anatomy
Physiology
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 19
Cont… Discuss the anatomical pathway and
distribution of 9thand 10th nerve.
Discuss lesions at different sites.
Anatomical pathways of 11th nerve,
distribution & functions and dysfunctions.
Discuss Anatomical pathway of 12thnerve
distribution functions and dysfunction
Discuss clinical evaluation of cranial
nerves. (A)
Lecture
Practical
Tutorial
1hr
3hrs
2 hrs
Physiology
Physiology
,,
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 20
Neuroscience module
Sensory system
Objectives
Broad content area Learning strategy Duration Department
1.0. Describe a sensory receptor
and its adaptation to its function
Define a sensory receptor and describe basic
anatomical and physiological features.
Name and define the types of sensory
receptors
Physiological basis of sensory transmission
Explain adaptation on sensory receptors. (A)
Lecture 1hr
Physiology
2.0. Describe the somato sensory
pathways, sensory modalities and
the anatomical basis of sensory
impairment.
Dorsal column pathways. Touch, position
sense, vibration, propioception,steriognosis,
graphesthesia
Spino-cerebellar tracts. (A)
Lecture
Demonstration.
2hrs
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 21
2.1. Describe perception of
different modalities of pain in the
brain.
2.2. Describe the physiology of
pain and physiological and
surgical methods of pain relief.
Pain and temperature
Anterior, lateral spinothalamic tracts. (The
student should be able to interpret
ascending pathways at spinal cord medulla,
pons and midbrain.) (A)
Intensity location and quality of different
sensation encoded in the brain.
Describe the difference between
Fast and slow pain
Superficial, deep and visceral pain.
Describe referred pain and phantom limb
Define hyperalgesia
Endogenous analgesic system.
Describe pain relieving methods and their
basis. (C)
Lecture
Lecture
Lecture
1hr
1hr
1hr
Physiology
Physiology
Physiology
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 22
3.0. Discuss basic pathologies
of the sensory pathways.
Tabes dorsalis, Syringomyelia,
Pernecious anaemia and multiple
sclerosis.
Traumatic lesions of the spinal cord. (B)
Spinal Shock
Lecture
PBL
2hrs
3hrs
Physiology
Physiology+Anatomy
4.0. Describe the
embryological, anatomical and
physiological basis of the
Visual system and accessory
structures of the eye ball.
Discuss the development of eye and
relate its attachments to the brain.
Describe visual pathway and the
organizations of visual cortex, the
anatomical basis for visual field changes
Describe the structure and how it is
related to function of the layers, cavities
and receptor cells of the eye ball.
Describe retina and explain how it’s
adopted to its function. (A)
Discuss night blindness & vitamin A
deficiency.
Color blindness and strabismus. (B)
Lecture
Lecture
Dissection
SGD
Lecture
Lecture
1hr
1hr
1hr
2hrs
Anatomy
Physiology
Anatomy
Physiology
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 23
Explain the principles of refraction,
accommodation and convergence.
Discuss hyperopia, myopia, astigmatism,
presbiopia. (B)
Lecture.
Tutorial
1hr
1hr
Physiology
,,
5.0. Describe capture and
transmission of sounds in the ear.
Explain how sound waves are
converted into generator potential.
6.0. Describe the major structures
of the vestibular and cochlea
system and its physiological basis
of hearing and equilibrium.
Describe the anatomy of the external,
middle & inner ear, labyrinth & how it’s
related to their functions.
Explain sound transmission, bone
conduction, air conduction. (A)
Describe the innervations of the cochlea.
Describe the neural pathways of auditory
system and explain pitch, loudness, timbre. (A)
Lecture
Model
demonstration
SGD
Combined practical
Lecture
Tutorial
1hr
2hrs
3hrs
1hr
1 hrs
Anatomy
Anatomy
Physiology
Physiology
Physiology
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 24
The role of semi circular canals in rotational
acceleration.
The role of saccule and utricle in linear
acceleration.
Evaluation of hearing disorders, basics of
Rinne’s& Weber’s tests and audiometry. (A)
Lecture
Practical
1hr
3 hrs
Physiology
Physiology
7.0. Relate the structure of
gustatory receptors to function,
identify the basic tastes.
Describe the neural pathway
Types of taste buds, structure & distribution.
Describe the basic taste modalities.
Substance evoking taste sensation, taste
thresholds and intensity discrimination,
receptor stimulation.
Trace the neural pathway. (B)
Lecture/PBL based
on 7th nerve palsy.
(Done with 7th nerve)
1/2hr
Anatomy
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 25
Neuroscience module
Motor System
Objectives
Broad content area Learning strategy Duration Department
1.0. Describe the anatomical,
biochemical and physiological
basis of motor system.
Describe the structure and function of the
proprioceptive receptors in the skeletal muscle.
Explain the effect of gamma efferent discharge.
Explain the function of a muscle spindle.
Explain the function of the golgi tendon organ
as a regulator of muscle force.
Describe the stretch reflex.
Describe mono synaptic poly synaptic reflexes.
Elaborate with examples common stretch
reflexes and their clinical significance. (A)
Lecture
2hrs
Physiology
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 26
Define reciprocal innervation, inverse
stretch reflex, clonus, and lengthening
reaction.
Explain withdrawal reflex and its clinical
importance:-mass reflex, hypotoniaand
hypertonia. (A)
2.0. Describe the cortical
mortar areas and their
activity.
2.1 Describe the descending
motor pathway and function.
Arrangement of motor cortex.
Explain manifestations due to lesions in the
cerebral cortex.
Describe physiological basis of Cerebral
palsy (A)
Describe the descending motor pathway.
Physiological basis of clinical features of
LMN and UMN lesions.
Compare and contrast clinical features of
UMN and LMN lesions
Cross sections of the spinal cord and brain
stem (A) Explain the physiological basis of clinical
features in CVA.
Dissection/
Lecture-demonstration
Lecture
SGD
PBL
2hrs
3hrs
2hrs
3 hrs
Anatomy
Anatomy/Physiology
Physiology
Anatomy/Physiology
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 27
3.0. Describe the anatomy and
functions of the extra pyramidal
system.
List the components of the extra pyramidal
system.
Structure and function of basal ganglia.
Explain the structure and function of the
nigrostriataldoperminergic system. (A)
Explain the physiological basis of Signs and
symptoms of Parkinson’s disease and
Huntington’s chorea. (B)
Lecture
demonstration
Lecture
3hrs
2hrs
Anatomy
Physiology
4.0. Describe the structure and
function of the cerebellum.
Briefly Describe the divisions of the
cerebellum and their connections.
Describe the evolutionary significances of
structure with function
Out line the functions of the cerebellum. (A)
Dissections
Demonstrations
Lecture
3hrs
2hrs
1hr
Anatomy
Anatomy
Physiology
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 28
Neuroscience module
Higher functions, sleep and hypothalamus
Objectives Broad content area Learning strategy Duration Department
1.0. Discuss physiological basis of
Memory & learning.
Discuss the anatomy of the
limbic system.
Describe the stages of memory
& neurological basis of memory,
learning habituation &
sensitization. (A)
Lecture-
demonstration
Lecture
1hr
1hr
Anatomy
Physiology
2.0. Discuss physiological basis of
Sleep & consciousness.
Explain the structure and
function of the reticular
formation. Describe the primary
types of rhythms that constitute
the normal EEG and behavioral
correlation of each of them.
Define synchronization
Alpha block
De synchronization (B)
Lecture/practical
Practical
1hr
3 hrs
Physiology
,,
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 29
Explain the EEG and behavioral
characteristic of
slow wave sleep
REM sleep (C) Compare and contrast slow wave sleep and
REM sleep. (B)
Describe pattern of normal night time sleep
in adult age and the variation in the sleep
pattern from birth to old age.
Briefly describe sleep disorders.
Explain the concept of consciousness, altered
consciousness & brain death.(C)
3.0. Discuss physiological and
anatomical basis of Speech
Neural control of speech, mechanism of
speech production and
Speech disorders. (C)
Lecture 1hr
Physiology
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 30
4.0. Hypothalamus Identify the location and
connection of the
hypothalamus.
List the functions.
Explain temperature
regulation, thirst mechanism
and appetite control.
Explain the
Neuroendocrine functions. (A)
Lecture 2 hrs Physiology
Musculoskeletal, Neuroscience & Clinical Biochemistry Page 31
Case Scenario 01
One of your friends had an accidental fall from height and has been admitted to the hospital.
You also went with the patient to the hospital. As you are a medical student you were allowed
to stay while the doctors examined the patent. The house officer in the ward told you that the
patient had injury to the spinal cord most probably at the level of T 10. The doctor further
informed you that the patient is in spinal shock.
When you came home you wanted to know more about the spinal shock and how the
doctors suspect that the patient had spinal cord injury at the level of T 10 by only
examining the patient.
When you visited the patient after several weeks later you found that he had developed
features of upper motor neuron lesions in his lower limbs.
What do you mean by upper motor neuron lesions and what are the clinical features
you would see in this patient?
Case Scenario 02
One of your uncles had developed sudden onset weakness in the right side of the body and
had been admitted to the hospital. When you visited the hospital to see him, you were
allowed to look at the hospital notes. You found several medical terms written in the notes.
These include stroke, lesion at the left side internal capsule, exaggerated tendon reflexes and
extensor planter response in the right side
You wanted to know more about these terms to understand the condition
When you visited the ward one week later you found that your uncle’s condition has
improved. He showed another patient just next to his bed who was having the same problem
(weakness in the right side of the body) but he could not speak. You noticed that this patient
can very well understand what others say but can’t produce speech.
You wanted to know why this patent had difficulty in speech and how this happened.
What are the other types of language disorders?