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School Neuropsychology Post-Graduate Certification Program KIDS, Inc. (schoolneuropsych.com)’s School-Neuropsychology Post-Graduate Certification Program 1 This compiled lecture material is copyrighted by KIDS, Inc. and cannot be used in any form outside of the KIDS, Inc.’s School Neuropsychology Post-Graduate Certification Program or the School Neuropsychology Alumni Connection Blackboard™ site without the express written consent from KIDS, Inc. 2 Copyright (C) KIDS, Inc. 1 School Neuropsychology Post-Graduate Certification Program • • • • • • • • • • • General Brain Neuroanatomy Neuroanatomy of Sensory-Motor Functions Neuroanatomy of Attention Neuroanatomy of Visual-Spatial Processes Neuroanatomy of Language Neuroanatomy of Memory and Learning Neuroanatomy of Executive Functions Neuroanatomy of Reading Neuroanatomy of Writing Neuroanatomy of Math Neuroanatomy of Emotions 3 4 Copyright (C) KIDS, Inc. 2 School Neuropsychology Post-Graduate Certification Program The largest portion of the brain is the cerebrum. It consists of two hemispheres that are connected together at the corpus callosum. Corpus callosum The cerebrum is often divided into five lobes that are responsible for different brain functions. 5 Neocortex The cerebrum’s surface—the neocortex—is convoluted into hundreds of folds. The neocortex is where all the higher brain functions take place. 6 Copyright (C) KIDS, Inc. 3 School Neuropsychology Post-Graduate Certification Program • The cerebral cortex is a thin layer of cells about 1.5 to 4 mm thick. • The cortex provides the connections and pathways for the highest cognitive functions, such as language and abstract thinking. • The cerebral cortex contains about 25 billion neurons, more than 62,000 miles of axons, and 300,000,000,000,000 synapses. Neocortex layer The thin layer of the neocortex is dense with neurons. 7 Limbic Lobe Frontal Lobe Parietal Lobe Temporal Lobe Occipital Lobe 8 Copyright (C) KIDS, Inc. 4 School Neuropsychology Post-Graduate Certification Program • Divided into two basic systems: – Peripheral nervous system - connects the CNS to the rest of the body • Spinal nerves • Cranial nerves • Peripheral nerves – Central nervous system 9 • 12 sets within the brainstem – Convey sensory information from sensory systems of head – Control special movements of head (movements of eyes and tongue) 10 Copyright (C) KIDS, Inc. 5 School Neuropsychology Post-Graduate Certification Program I. Olfactory nerve II. Optic nerve III. Oculomotor nerve IV. Trochlear nerve V. Trigeminal nerve VI. Abducens nerve VII. Facial nerve VIII. Vestibulocochlear nerve IX. Glossopharyngeal nerve X. Vagus nerve XI. Accessory nerve XII. Hypoglossal nerve 11 • Can't remember the names of the cranial nerves? Here is a handy-dandy mnemonic for you: On Old Olympus Towering Top A Famous Vocal German Viewed Some Hops. • The capital letters stand for: – olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, spinal accessory, hypoglossal. 12 Copyright (C) KIDS, Inc. 6 School Neuropsychology Post-Graduate Certification Program • Large cavities filled with cerebrospinal fluid. • Reside in various regions of the brain. • The fourth ventricle (aqueduct of Sylvius) resides in the brain stem at the level of the pons and the medulla. • The third ventricle is located in the diencephalon (between brains). • Enlargement of these ventricles can be used for diagnosing tumor or disease processes including: hydrocephalus, encephalitis, and meningitis. 13 • The ventricles are a complex series of spaces and tunnels through the center of the brain. • The ventricles secrete cerebrospinal fluid, which suspends the brain in the skull. • The ventricles also provide a route for chemical messengers that are widely distributed through the central nervous system. 14 Copyright (C) KIDS, Inc. 7 School Neuropsychology Post-Graduate Certification Program 15 • Cerebrospinal fluid is a colorless liquid that bathes the brain and spine. • It is formed within the ventricles of the brain, and it circulates throughout the central nervous system. • Cerebrospinal fluid fills the ventricles and meninges, allowing the brain to “float” within the skull. 16 Copyright (C) KIDS, Inc. 8 School Neuropsychology Post-Graduate Certification Program • Myelencephalon • Metencephalon • Mesencephalon • Diencephalon 17 • The lower extension of the brain where it connects to the spinal cord. Neurological functions located in the brainstem include those necessary for survival (breathing, digestion, heart rate, blood pressure) and for arousal (being awake and alert). • Most of the cranial nerves come from the brainstem. The brainstem is the pathway for all fiber tracts passing up and down from peripheral nerves and spinal cord to the highest parts of the brain. 18 Copyright (C) KIDS, Inc. 9 School Neuropsychology Post-Graduate Certification Program Front Rear 19 Midbrain Pons Medulla Oblongata 20 Copyright (C) KIDS, Inc. 10 School Neuropsychology Post-Graduate Certification Program • Myelencephalon • Medulla Oblongata • Metencephalon • Mesencephalon • Diencephalon 21 • Medulla Oblongata or bulb - The medulla oblongata functions primarily as a relay station for the crossing of motor tracts between the spinal cord and the brain. • It also contains the respiratory, vasomotor and cardiac centers, as well as many mechanisms for controlling reflex activities such as coughing, gagging, swallowing and vomiting. 22 Copyright (C) KIDS, Inc. 11 School Neuropsychology Post-Graduate Certification Program • Significant injury to the medulla oblongata or bulb generally results in death. • Damage to the lateral medullary structures can result in sensory deficits. 23 The medulla oblongata merges seamlessly with the spinal cord and creates the base of the brainstem. The medulla is primarily a control center for vital involuntary reflexes such as swallowing, vomiting, sneezing, coughing, and regulation of cardiovascular and respiratory activity. The medulla is also the origin of many cranial nerves. 24 Copyright (C) KIDS, Inc. 12 School Neuropsychology Post-Graduate Certification Program • A continuation of the spinal cord. • Contains nerve tracts similar to those found in the spinal cord. • Groups of sensory and motor nuclei are arranged in ascending (i.e., afferent - sensory tracts) or descending (i.e., efferent - motor tracts) cell columns. 25 • Projections of the major cranial nerves occur at the level of the medulla including: – the hypoglossal (tongue) – the glossopharyngeal (pharynx and larynx) – the accessory (neck muscles) 26 Copyright (C) KIDS, Inc. 13 School Neuropsychology Post-Graduate Certification Program • Neural crossing takes place at the medulla: – Sensory and motor tracts cross over into the opposite side of the brain. – The somatosensory (touch, pressure, pain, and temperature) and the motor systems are organized in contralateral fashion, such that sensory information and movement on the left side of the body are primarily controlled by the right hemisphere. – The visual and auditory systems are also crossed in the medulla area. 27 • Reticular activating system (reticular formation) – Mixture of fibers and cells in the brainstem with fibers from the spinal cord passing through the brainstem on their way to the forebrain and fibers from the forebrain passing through the brainstem on their way to the spinal cord. • RAS comprises a major portion of the medulla and extends into the midbrain area. 28 Copyright (C) KIDS, Inc. 14 School Neuropsychology Post-Graduate Certification Program • The brainstem controls the basic functions of life. Damage to these areas of the brain are usually fatal: • The pons plays a critical role in respiration. • The medulla oblongata is responsible for respiration and cardiovascular functions. Pons Medulla Oblongata 29 • RAS functions: – Control blood pressure – Blood volume in the organs – Heart rate – Regulate sleep and wakefulness • Because the RAS is directly or indirectly connected to much of the CNS it can modulate CNS activity. 30 Copyright (C) KIDS, Inc. 15 School Neuropsychology Post-Graduate Certification Program • Brain stem lesions involving the RAS give rise to sleep disturbances and to global disorders of consciousness and responsivity such as drowsiness, somnolence, stupor, or coma. 31 • The RAS, considered the arousal system, plays an important role in maintaining consciousness and attentional states for the entire brain. • The RAS has been hypothesized as one of the critical mechanisms involved in ADHD. 32 Copyright (C) KIDS, Inc. 16 School Neuropsychology Post-Graduate Certification Program • Myelencephalon • Metencephalon • Pons • Cerebellum • Mesencephalon • Diencephalon 33 • Pons - The pons is a bridge-like structure which links different parts of the brain and serves as a relay station from the medulla to the higher cortical structures of the brain. It contains the respiratory center. • Major sensory and motor pathways move through the pons. 34 Copyright (C) KIDS, Inc. 17 School Neuropsychology Post-Graduate Certification Program • The pons is the rounded brainstem region between the midbrain and the medulla oblongata. In fact, pons means “bridge” in Latin. • The main function of the pons is to connect the cerebellum to the rest of the brain and to modify the respiratory output of the medulla. • The pons is the origin of several cranial nerves. 35 • The pons, in coordination with the cerebellum, receives information concerning movements from the motor cortex and helps modulate movements. • Information from the visual cortex is also received at the pontine level, which serves to guide visually determined movements. 36 Copyright (C) KIDS, Inc. 18 School Neuropsychology Post-Graduate Certification Program Information from the hypothalamus and the limbic system converge in the pons and may influence the impact of emotional and motivational factors on motor activity. 37 • A number of cranial nerves converge in the pons: – Trigeminal nerve (swallowing and chewing) – Nervus facillis (moving facial muscles and affecting hearing and equilibrium in the inner ear) – Abducens (the eye muscles) • Lesions of the pons may cause motor, sensory, and coordination disorders. 38 Copyright (C) KIDS, Inc. 19 School Neuropsychology Post-Graduate Certification Program Also called the hindbrain. Posterior to the brain stem. Connects to the midbrain, pons, and medulla. Receives sensory information about where the limbs are in space and signals where muscles should be positioned. • Receives information from the semicircular canals (in the inner ear) concerning orientation in space. • • • • 39 The cerebellum is connected to the brainstem, and is the center for body movement and balance. 40 Copyright (C) KIDS, Inc. 20 School Neuropsychology Post-Graduate Certification Program • Involved in the unconscious adjustment of muscles in the body for coordinated, smooth, and complex motor activity. • Damage may result in ataxia which is a problem of muscle coordination. This can interfere with a person's ability to walk, talk, eat, and to perform other self care tasks. 41 • Damage may result in: – dysarthria (slurred speech) – nystagmus (blurred vision and dizziness) – hypotonia (loss of muscle tone) • Tumors involving the cerebellum and the fourth ventricle are the most common type of brain tumor affecting young children (Cohen & Duffner, 1994). 42 Copyright (C) KIDS, Inc. 21 School Neuropsychology Post-Graduate Certification Program • Impairment of equilibrium • Postural defects • Impairments of skilled motor activity 43 • Highly organized neural pathways from both lower and higher areas of the brain project through the pons to the cerebellum. • The cerebellum projects through the thalamus to the same cortical areas from which it receives input, including frontal, parietal, and superior temporal cortices. 44 Copyright (C) KIDS, Inc. 22 School Neuropsychology Post-Graduate Certification Program • Through its connections with these cortical areas and with subcortical sites, cerebellar lesions can: – Disrupt abstract reasoning – Verbal fluency – Visuospatial abilities – Attention – Emotional modulation – Planning – Time judgment 45 • Cerebellar lesions can cause deficits in: – Linguistic processing – Set shifting – Working memory – Memory and learning, especially habit formation – Speed of information processing slows with cerebellar lesions. – Personality changes and psychiatric disorders have also been linked to cerebellar dysfunction. 46 Copyright (C) KIDS, Inc. 23 School Neuropsychology Post-Graduate Certification Program • Myelencephalon • Metencephalon • Mesencephalon • Tectum • Tegmentum • Cerebral aqueduct • Diencephalon 47 • The most anterior region of the brain stem. • Its functioning may be a prerequisite for conscious experience. • Serves a major relay function for sensorymotor fibers. • Two major divisions in the midbrain: – Tegmentum – Tectum 48 Copyright (C) KIDS, Inc. 24 School Neuropsychology Post-Graduate Certification Program • Tectum (roof), above the cerebral aqueduct, consists of two bilaterally symmetrical nuclei: (Dorsal portion – sensory) – Superior colliculi • Receive projections from retina • Mediate visual related behaviors – Inferior colliculi • Receive projections from ear • Mediate auditory related behaviors. 49 • Tegmentum (floor), below the aqueduct and is separated by the substantia nigra (Ventral portion – motor) – Contains nuclei of some of the cranial nerves – Intermingled are motor nuclei 50 Copyright (C) KIDS, Inc. 25 School Neuropsychology Post-Graduate Certification Program • Midbrain lesions have been associated with specific movement disabilities such as certain types of tremors, rigidity, and extraneous movements of local muscle groups. • Even impaired memory retrieval has been associated with damage to midbrain pathways projecting to structures in the memory system. 51 • A number of cranial nerves are located in the midbrain: – Oculomotor nerve (moves the eyes laterally and downward and regulates pupil size and lens shape) – Trigeminal nerve (major sensory nerve of the face) 52 Copyright (C) KIDS, Inc. 26 School Neuropsychology Post-Graduate Certification Program 53 54 Copyright (C) KIDS, Inc. 27 School Neuropsychology Post-Graduate Certification Program • The superior region of the brain stem. • Contains major relay and integrative centers for all sensory systems except smell. • This region of the brain is not clearly demarcated but includes: – • thalamus – • hypothalamus – • pituitary • internal capsule • third ventricle • optic nerve 55 • “Inner body or room” – Small, paired, somewhat oval structure lying along the right and left sides of the third ventricle. – Consists of a number of nuclei. – Relays for all sensory systems except olfaction on their way to cortex. – Communication relays for different parts of the cortex. 56 Copyright (C) KIDS, Inc. 28 School Neuropsychology Post-Graduate Certification Program Prefrontal cortex • Emotions are an extremely complex brain function. The emotional core of the brain is the limbic system. This is where senses and awareness are first processed in the brain. • Mood and personality are mediated through the prefrontal cortex. This part of the brain is the center of higher cognitive and emotional functions. Limbic system 57 The thalamus is called the gateway to the cerebral cortex, as nearly all sensory inputs pass through it to the higher levels of the brain. 58 Copyright (C) KIDS, Inc. 29 School Neuropsychology Post-Graduate Certification Program • Body sensations may be degraded or lost with damage to appropriate thalamic nuclei with an associated impairment of the abilities to make tactile discrimination and identification of what is felt (tactile object agnosia). • Pain sensation typically remains intact or is mildly diminished; however, with some kinds of thalamic damage it may be heightened to an excruciating degree. 59 • Other thalamic nuclei are relay pathways for vision, hearing, and taste. • Other areas are relay nuclei for limbic structures. • Motor nuclei receive input from the cerebellum and the basal ganglia and project to the motor association cortex. • As the termination site for the RAS, it plays an important role in arousal and sleepproducing functions. 60 Copyright (C) KIDS, Inc. 30 School Neuropsychology Post-Graduate Certification Program • Two types of memory impairments tend to accompany thalamic lesions: – Learning is compromised (anterograde amnesia) • Possibly by defective encoding which makes effective retrieval difficult if not impossible. • Possibly by a diminished capacity of learning processes to free up readily for succeeding exposures to new information (defective release from proactive inhibition). A rapid loss of newly acquired information may also occur. – Recall of past information is defective (retrograde amnesia). 61 • Alterations of emotional capacity and responsivity tend to accompany thalamic damage: – Apathy – Loss of spontaneity and drive – Affective flattening 62 Copyright (C) KIDS, Inc. 31 School Neuropsychology Post-Graduate Certification Program • Bilateral thalamic lesions: – Diminished behavior and emotions • Right thalamic lesions: – Transient manic episodes • Left thalamic lesions: – Strong emotional responses not nearly as those associated with right lesions. 63 • “Lower room” – Composed of 22 small nuclei, fibers systems that pass through it and the pituitary gland. – Comprises only 0.3% of brain’s weight. – Nearly all aspects of behavior pass through it (feeding, sexual behavior, sleeping, temperature regulation, emotional behavior, endocrine function and movement). 64 Copyright (C) KIDS, Inc. 32 School Neuropsychology Post-Graduate Certification Program • The hypothalamus sits under the thalamus at the top of the brainstem. Although the hypothalamus is small, it controls many critical bodily functions: • Controls autonomic nervous system • Center for emotional response and behavior • Regulates body temperature • Regulates food intake • Regulates water balance and thirst • Controls sleep-wake cycles • Controls endocrine system The hypothalamus is shaded blue. The pituitary gland extends from the hypothalamus. 65 • Lesions to hypothalamic nuclei can result in a variety of symptoms including: – Obesity – Disorders of temperature control – Diminished drive states and responsivity. – Altered mood states – Damage to the mammillary bodies in the posterior hypothalamus disrupts memory processing. 66 Copyright (C) KIDS, Inc. 33 School Neuropsychology Post-Graduate Certification Program • Situated lateral to the thalamus • Contains fibers connecting the cortex to the lower brain regions, including the brain stem and spinal cord. • Major fibers comprise the internal capsule and connect the frontal cortical regions to the thalamus and to the pons. 67 • Converges in the diencephalon and forms the optic chiasm. • Fibers from the optic nerve cross at the chiasm and project to the lateral geniculate body (occipital cortex) via the optic tract. 68 Copyright (C) KIDS, Inc. 34 School Neuropsychology Post-Graduate Certification Program Brain Divisions Telencephalon (endbrain) Brain Structures • Neocortex • Basal ganglia • Limbic system • Olfactory bulbs • Lateral ventricles Functional Divisions Forebrain 69 • Within each cerebral hemisphere, at its base, are situated a number of nuclear masses known as the basal ganglia. • Basal ganglia is composed of: – Caudate – Putamen – Globus pallidus 70 Copyright (C) KIDS, Inc. 35 School Neuropsychology Post-Graduate Certification Program • In some references the basal ganglia is composed of: – Amygdala – Subthalamic nuclei – Substantia nigra – Other subcortical structures 71 72 Copyright (C) KIDS, Inc. 36 School Neuropsychology Post-Graduate Certification Program • The caudate and the putamen can be considered as part of the system that translates cognition into action. • The basal ganglia structures influence all aspects of motor control. • Movement disorders are the most common and obvious of basal ganglia damage. 73 • The basal ganglia neurons are not motor neurons in a strict sense. • Damage to these neurons causes motor disturbances but not paralysis. • Diseases of the basal ganglia are characterized by abnormal involuntary movements as rest (e.g., Parkinson’s Disease and Huntington’s disease). 74 Copyright (C) KIDS, Inc. 37 School Neuropsychology Post-Graduate Certification Program • Due to a depletion of a neurotransmitter called dopamine in the neostriatum (caudate and putamen) due to degeneration of the substantia nigra. • Caused the poverty of movement associated with the disease. 75 • Loss of neurons in the caudate nucleus. • Excessive motor movements. • Huntington’s and Parkinson’s patients seems to have trouble initiating cognitive processes and control over cognitive processes. • Emotional disturbances may be present. 76 Copyright (C) KIDS, Inc. 38 School Neuropsychology Post-Graduate Certification Program • Also implicated in the procedural memory system. • Seems to act as a buffer for establishing procedural skills and response patterns and participating in the development of new response strategies (skills) for novel situations. • Damage to the basal ganglia - reduced cognitive flexibility and set shifting. 77 • Alterations in the nonmotor areas of the basal ganglia have been associated with: – Schizophrenia – Obsessive-compulsive disorder – Depression – Tourette’s syndrome – Autism – Attention Deficit Disorders • Emotional flattening and reduced drive = bilateral basal ganglia damage. 78 Copyright (C) KIDS, Inc. 39 School Neuropsychology Post-Graduate Certification Program 79 The limbic lobe is located deep in the brain, and makes up the limbic system. 80 Copyright (C) KIDS, Inc. 40 School Neuropsychology Post-Graduate Certification Program The limbic system is the area of the brain that regulates emotion and memory. It directly connects the lower and higher brain functions. A. B. C. D. E. F. Cingulate gyrus Fornix Anterior thalamic nuclei Hypothalamus Amygdaloid nucleus Hippocampus 81 • Small structure located deep in the anterior part of the temporal lobe. • It has input and output connections with the cerebral cortex, hippocampus, basal ganglia, thalamus, hypothalamus and brain stem nuclei. 82 Copyright (C) KIDS, Inc. 41 School Neuropsychology Post-Graduate Certification Program • Plays an important role in: – Emotional processing and learning – Modulation of attention – Vegetative and protective drive states (e.g., chewing, salivating, licking, and gagging) – Movement patterns – Associated emotional responses – Processing of facial expressions of fear – Provides an emotional tag to memory traces • Damage to the amygdala: – Hypersexuality – Diminished aggressive capacity 83 84 Copyright (C) KIDS, Inc. 42 School Neuropsychology Post-Graduate Certification Program • Located in the medial aspects of the hemispheres above the corpus callosum. • Has important influences on: – Selective Attention – Response selection. Together with the lateral prefrontal cortex controls behavior by detecting errors and signaling the occurrences of conflicts during information processing. – Self-initiated behaviors – Emotional behavior – Pain perception 85 86 Copyright (C) KIDS, Inc. 43 School Neuropsychology Post-Graduate Certification Program • Runs within the inside fold of each temporal lobe for much of its length. • Converging evidence from lesion studies, epilepsy surgery, and functional imaging studies point to a primary role in normal learning and retention. • Interactions between perception and memory systems with a particular role in spatial memory. 87 • Has been described as using a “snapshot” type of processing to remember a scene or episode with its unique elements and contextual features. • The hippocampus can later activate retrieval of the whole representation when a small part of the representation occurs. 88 Copyright (C) KIDS, Inc. 44 School Neuropsychology Post-Graduate Certification Program • Bilateral damage - severe anterograde amnesia. • Left hippocampal damage - verbal memory damage. • Right hippocampal damage - defective recognition and recall of complex visual and auditory patterns to which a name cannot readily be assigned. 89 • • • • • • • • • • • General Brain Neuroanatomy Neuroanatomy of Sensory-Motor Functions Neuroanatomy of Attention Neuroanatomy of Visual-Spatial Processes Neuroanatomy of Language Neuroanatomy of Memory and Learning Neuroanatomy of Executive Functions Neuroanatomy of Reading Neuroanatomy of Writing Neuroanatomy of Math Neuroanatomy of Emotions 90 Copyright (C) KIDS, Inc. 45 School Neuropsychology Post-Graduate Certification Program Optic chiasm Lateral geniculate body 91 There are two auditory areas of the brain: • The primary auditory area (brown circle) is what detects sounds that are transmitted from the ear. It is located in the sensory cortex. • The auditory association area (purple circle) is the part of the brain that is used to recognize the sounds as speech, music, or noise. 92 Copyright (C) KIDS, Inc. 46 School Neuropsychology Post-Graduate Certification Program The primary auditory cortex is located in the superior part of the temporal lobe and buried within the sylvian fissure. Left Auditory cortex Right Auditory cortex Medial geniculate nucleus Cochlea Inferior colliculus Auditory nerve fiber Ipsilateral Cochlear nucleus Superior Olivary nucleus 93 Pathway for pain and temperature sense. fMRI of the Sensation of pain 94 Copyright (C) KIDS, Inc. 47 School Neuropsychology Post-Graduate Certification Program The axons project to the corresponding lemniscal somatosensory area of the cerebral cortex located in the postcentral gyrus of the parietal lobe. 95 The parietal lobe plays a role in our sensations of touch, smell, and taste. It also processes sensory and spatial awareness, and is a key component in eyehand co-ordination and arm movement. The parietal lobe also contains a specialized area called Wernicke’s area that is responsible for matching written words with the sound of spoken speech. 96 Copyright (C) KIDS, Inc. 48 School Neuropsychology Post-Graduate Certification Program 97 The motor portion of the cerebrum is illustrated here. The light red area is the premotor cortex, which is responsible for repetitive motions of learned motor skills. The dark red area is the primary motor area, and is responsible for control of skeletal muscles. Different areas of the brain are associated with different parts of the body. Injury to the motor cortex can result in motor disturbance in the associated body part. 98 Copyright (C) KIDS, Inc. 49 School Neuropsychology Post-Graduate Certification Program • The motor cortex is divided into two main areas, Area 4 and Area 6. Area 4, also known as the primary motor cortex, forms a thin band along the central sulcus. Area 6 lies immediately forward of Area 4. Area 6 is wider and is further subdivided into two distinct sub-areas: the supplementary motor cortex and the premotor cortex. 99 Primary motor cortex (M1) Hip Trunk Notice that various body parts on the cortex are proportional not to their size, but rather to the complexity of the movements that they can perform. Arm Hand Foot Face Tongue Larynx 100 Copyright (C) KIDS, Inc. 50 School Neuropsychology Post-Graduate Certification Program The gustatory complex (green circle) is the part of the sensory cortex (purple area) that is responsible for taste. 101 The primary olfactory cortex is located in the ventral region of the anterior temporal lobe. A secondary region for olfaction is located in the lateral parts of the orbitofrontal cortex. 102 Copyright (C) KIDS, Inc. 51 School Neuropsychology Post-Graduate Certification Program • • • • • • • • • • • General Brain Neuroanatomy Neuroanatomy of Sensory-Motor Functions Neuroanatomy of Attention Neuroanatomy of Visual-Spatial Processes Neuroanatomy of Language Neuroanatomy of Memory and Learning Neuroanatomy of Executive Functions Neuroanatomy of Reading Neuroanatomy of Writing Neuroanatomy of Math Neuroanatomy of Emotions 103 Attentional Implicated Process Brain Structure Focus/Selective Anterior Cingulate, dorsolateral prefrontal cortex Sustained Dorsolateral prefrontal cortex, orbitofrontal cortex, thalamus, anterior cingulate Shifting Left inferior frontal gyrus; rostrodorsal prefrontal cortex, left parietal, orbitofrontal cortex, dorsolateral prefrontal Divided Left prefrontal and medial temporal 104 Copyright (C) KIDS, Inc. 52 School Neuropsychology Post-Graduate Certification Program Lack of firing and reduced distribution of norepinephrine is associated with: – Inattention – Increased drowsiness – Sleep 105 • • • • • • • • • • • General Brain Neuroanatomy Neuroanatomy of Sensory-Motor Functions Neuroanatomy of Attention Neuroanatomy of Visual-Spatial Processes Neuroanatomy of Language Neuroanatomy of Memory and Learning Neuroanatomy of Executive Functions Neuroanatomy of Reading Neuroanatomy of Writing Neuroanatomy of Math Neuroanatomy of Emotions 106 Copyright (C) KIDS, Inc. 53 School Neuropsychology Post-Graduate Certification Program The visual cortex resides in the occipital lobe of the brain. Sensory impulses travel from the eyes via the optic nerve to the visual cortex. Damage to the visual cortex can result in blindness. 107 108 Copyright (C) KIDS, Inc. 54 School Neuropsychology Post-Graduate Certification Program • The striate cortex is colored in red. The striate cortex is the initial projection area within the occipital lobe for perception. (Luria’s primary zone) • Functions include: perception of color, sensitivity to contrast, ability to detect fine details, and temporal (time) resolution. 109 • The extrastriate cortex is colored in yellow and orange. Neurons in the striate cortex send axons to the extrastriate cortex, where perception of objects takes place. (Luria’s secondary zone). 110 Copyright (C) KIDS, Inc. 55 School Neuropsychology Post-Graduate Certification Program The visual cortex can be divided into smaller regions (Brodmann’s Areas) that have known specific functions (e.g., V8 - color perception, LO - object recognition, V7 - visual attention). 111 • Dorsal stream - recognizes where the object is located and whether it is moving. Occipital-parietal pathway. • Ventral stream - recognizes what an object is and what color it has. Occipital-temporal pathway. 112 Copyright (C) KIDS, Inc. 56 School Neuropsychology Post-Graduate Certification Program The development of this region may be a result of extensive experience looking at faces. Fusiform face area (shown in green) The fusiform face area is underdeveloped in people with autism, probably because of insufficient motivation to become an expert in recognizing people’s faces. 113 • • • • • • • • • • • General Brain Neuroanatomy Neuroanatomy of Sensory-Motor Functions Neuroanatomy of Attention Neuroanatomy of Visual-Spatial Processes Neuroanatomy of Language Neuroanatomy of Memory and Learning Neuroanatomy of Executive Functions Neuroanatomy of Reading Neuroanatomy of Writing Neuroanatomy of Math Neuroanatomy of Emotions 114 Copyright (C) KIDS, Inc. 57 School Neuropsychology Post-Graduate Certification Program 115 Broca’s Area Broca’s area is where we formulate speech and the area of the brain that sends motor instructions to the motor cortex. Injury to Broca’s area can cause difficulty in speaking. The individual may know what words he or she wishes to speak, but will be unable to do so. Copyright (C) KIDS, Inc. 116 58 School Neuropsychology Post-Graduate Certification Program • Broca’s Area responsible for the production of language. • Prefrontal Cortex involved in shifting attention, an important attribute in reading comprehension (Mirsky) • Arcuate fasciculus connects anterior and posterior language areas 117 • Wernicke’s area is a specialized portion of the parietal lobe that recognizes and understands written and spoken language. • Wernicke’s area surrounds the auditory association area. • Damage to this part of the brain can result in someone hearing speech, but not understanding it. Auditory Association Area Wernicke’s Area 118 Copyright (C) KIDS, Inc. 59 School Neuropsychology Post-Graduate Certification Program Language functions located using Positron Emissions Tomography (PET) Scans 119 • • • • • • • • • • • General Brain Neuroanatomy Neuroanatomy of Sensory-Motor Functions Neuroanatomy of Attention Neuroanatomy of Visual-Spatial Processes Neuroanatomy of Language Neuroanatomy of Memory and Learning Neuroanatomy of Executive Functions Neuroanatomy of Reading Neuroanatomy of Writing Neuroanatomy of Math Neuroanatomy of Emotions 120 Copyright (C) KIDS, Inc. 60 School Neuropsychology Post-Graduate Certification Program • The temporal lobe plays a role in emotions, and is also responsible for smelling, tasting, perception, memory, understanding music, aggressiveness, and sexual behavior. • The temporal lobe also contains the language area of the brain. 121 Medial temporal areas Hippocampus 122 Copyright (C) KIDS, Inc. 61 School Neuropsychology Post-Graduate Certification Program Mishkin and Appenzeller (1987) conclude that severity of memory loss varies in proportion to the amount of damage sustained jointly by the amygdala and the hippocampus. 123 An fMRI of the brain. Green areas were active while subjects remembered information presented visually. Red areas were active while they remembered information presented aurally. Yellow areas were active for both types. 124 Copyright (C) KIDS, Inc. 62 School Neuropsychology Post-Graduate Certification Program 125 Working memory performance is typically associated with a fronto-parietal network. 126 Copyright (C) KIDS, Inc. 63 School Neuropsychology Post-Graduate Certification Program • • • • • • • • • • • General Brain Neuroanatomy Neuroanatomy of Sensory-Motor Functions Neuroanatomy of Attention Neuroanatomy of Visual-Spatial Processes Neuroanatomy of Language Neuroanatomy of Memory and Learning Neuroanatomy of Executive Functions Neuroanatomy of Reading Neuroanatomy of Writing Neuroanatomy of Math Neuroanatomy of Emotions 127 The prefrontal cortex is involved with intellect, complex learning, and personality. Injuries to the front lobe can cause mental and personality changes. 128 Copyright (C) KIDS, Inc. 64 School Neuropsychology Post-Graduate Certification Program • The frontal lobe is the area of the brain responsible for higher cognitive functions. • These include: • Problem solving, Planning • Spontaneity • Memory – Retrieval • Language • Motivation • Judgment • Impulse control • Social and sexual behavior. 129 1. Orbitofrontal 2. Prefrontal dorsolateral 3. Ventromedial prefrontal 4. Limbic system 5. Anterior Cingulate 130 Copyright (C) KIDS, Inc. 65 School Neuropsychology Post-Graduate Certification Program • Dorsolateral prefrontal circuit – Mediates “executive functions” • Anterior cingulate circuit – Involved in motivational mechanisms • Lateral orbitofrontal circuit – Responsible for the integration of emotional information into contextually appropriate behavioral responses. • Ventromedial orbitofrontal circuit – Regulates impulse control and internal emotional states 131 132 Copyright (C) KIDS, Inc. 66 School Neuropsychology Post-Graduate Certification Program 133 • • • • • • • • • • • General Brain Neuroanatomy Neuroanatomy of Sensory-Motor Functions Neuroanatomy of Attention Neuroanatomy of Visual-Spatial Processes Neuroanatomy of Language Neuroanatomy of Memory and Learning Neuroanatomy of Executive Functions Neuroanatomy of Reading Neuroanatomy of Writing Neuroanatomy of Math Neuroanatomy of Emotions 134 Copyright (C) KIDS, Inc. 67 School Neuropsychology Post-Graduate Certification Program • Involved in sensory and tactile functioning as well as visual-spatial orientation • inferior parietal lobe represents interface of occipital, temporal, and parietal regions--presumably the sect of higher level intelligence. • damage to left parietal lobe can lead to dyslexia, dysgraphia, and dyscalculia, whereas damage to the right can lead to deficits in visualspatial skills and constructional dyspraxia (VMI). 135 • Next, the brain needs to transform the letters into sounds of language, and ultimately attach meaning to those sounds. • The visual feature information of the word processed within the occipital lobe is passed onto one of two different brain pathways: an upper pathway, called the dorsal stream, emanates from the left parieto-temporal region and a lower pathway called the ventral stream is located at the junction of the occipital and temporal lobes, the occipito-temporal area. 136 Copyright (C) KIDS, Inc. 68 School Neuropsychology Post-Graduate Certification Program • The parieto-temporal system is essential for phonetic decoding in reading: initially analyzing a word, pulling it apart by phonemes, and linking the letters to sounds. • Specific brain regions that are activated in the parieto-temporal region include the angular gyrus and the supramarginal gyrus. • Children learning to read initially use the parieto-temporal system almost exclusively. 137 Involved in processing language, spatial orientation, and semantic representation. 138 Copyright (C) KIDS, Inc. 69 School Neuropsychology Post-Graduate Certification Program • Involved in both processing language and making phonemic discriminations. Plays key role in memory and emotion as well. • Left temporal lobe extremely critical for decoding 44 phonemes which comprise the English language • Vital for mediating VISUAL/ VERBAL tasks • Semantic memory and verbal short-term memory housed in temporal lobes. 139 1. Parieto-temporal pathway = phonetic decoding. 2. Left frontal (Broca’s area) = phonetic decoding. 3. Occipito-temporal pathway = automatically recognizing words in print (fluency) Good readers show a consistent pattern of activation in the back of the brain (the occipito-temporal pathway) with less activation in the front pathways (Shaywitz, 2003). 140 Copyright (C) KIDS, Inc. 70 School Neuropsychology Post-Graduate Certification Program 1. Parieto-temporal pathway = phonetic decoding. 2. Left frontal (Broca’s area) = phonetic decoding. 3. Occipito-temporal pathway = automatically recognizing words in print (fluency) Inefficient readers or children with dyslexia have shown the opposite pattern (Shaywitz, 2003). 141 • • • • • • • • • • • General Brain Neuroanatomy Neuroanatomy of Sensory-Motor Functions Neuroanatomy of Attention Neuroanatomy of Visual-Spatial Processes Neuroanatomy of Language Neuroanatomy of Memory and Learning Neuroanatomy of Executive Functions Neuroanatomy of Reading Neuroanatomy of Writing Neuroanatomy of Math Neuroanatomy of Emotions 142 Copyright (C) KIDS, Inc. 71 School Neuropsychology Post-Graduate Certification Program Dysgraphia Subtype • Lexical Agraphia Brain Region Involved • Lesions in the posterior part of the angular gyrus and the occipitotemporal region, along with other regions of the left hemisphere, excluding the perisylvian region. 143 Dysgraphia Subtype • Phonological agraphia Brain Region Involved • Lesions in the posterior perisylvanian region, including the supramarginal gyrus and insula. supramarginal gyrus insula 144 Copyright (C) KIDS, Inc. 72 School Neuropsychology Post-Graduate Certification Program Dysgraphia Subtype • Apraxia agraphia Brain Region Involved • Lesions involving the parietal lobe, either ipsilateral or contralateral to the hand used for writing. 145 Dysgraphia Subtype • Spatial apraxia Brain Region Involved • Lesions in the nondominant parietal lobes that often produces hemispatial neglect. 146 Copyright (C) KIDS, Inc. 73 School Neuropsychology Post-Graduate Certification Program • Berninger (2004) reported that writing components involved with fine motor control and language generation can be related to areas of the frontal lobes and the cerebellum. 147 • • • • • • • • • • • General Brain Neuroanatomy Neuroanatomy of Sensory-Motor Functions Neuroanatomy of Attention Neuroanatomy of Visual-Spatial Processes Neuroanatomy of Language Neuroanatomy of Memory and Learning Neuroanatomy of Executive Functions Neuroanatomy of Reading Neuroanatomy of Writing Neuroanatomy of Math Neuroanatomy of Emotions 148 Copyright (C) KIDS, Inc. 74 School Neuropsychology Post-Graduate Certification Program 149 In clinical groups with known dyscalculia (women with Turner’s syndrome), fMRI scans found reduced grey matter in the intraparietal sulcus (IPS) the area thought to be responsible for Number Sense. 150 Copyright (C) KIDS, Inc. 75 School Neuropsychology Post-Graduate Certification Program • • • • • • • • • • • General Brain Neuroanatomy Neuroanatomy of Sensory-Motor Functions Neuroanatomy of Attention Neuroanatomy of Visual-Spatial Processes Neuroanatomy of Language Neuroanatomy of Memory and Learning Neuroanatomy of Executive Functions Neuroanatomy of Reading Neuroanatomy of Writing Neuroanatomy of Math Neuroanatomy of Emotions 151 The limbic lobe is located deep in the brain, and makes up the limbic system. 152 Copyright (C) KIDS, Inc. 76 School Neuropsychology Post-Graduate Certification Program The limbic system is the area of the brain that regulates emotion and memory. It directly connects the lower and higher brain functions. A. B. C. D. E. F. Cingulate gyrus Fornix Anterior thalamic nuclei Hypothalamus Amygdaloid nucleus Hippocampus 153 Three Main Subcortical Brain Regions: 1. Amygdala - responds to unexpected and unfamiliar events (Kagan, 2007). Ascribes emotional valence to stimuli and responsible for fear conditioning. – A hyperactive amygdala source of most anxiety problems. – Kids with anxiety issues need structure in their day to reduce chances for unexpected and unfamiliar events. – Serotonin can help calm down amygdala, like a warm blanket over brain. 154 Copyright (C) KIDS, Inc. 77 School Neuropsychology Post-Graduate Certification Program 155 Three Main Subcortical Brain Regions: 2. Hippocampus - located in medial temporal lobe and responsible for laying down new memories in a sense of space a time, and retrieving older ones. – Chronic stress from abuse or neglect releases cortisol which reduces hippocampal volume and leads to memory loss and clouded thinking. – Emotional learning (classical conditioning) can take place outside of conscious control with paired association between amygdala and hippocampus …….a phobia!! 156 Copyright (C) KIDS, Inc. 78 School Neuropsychology Post-Graduate Certification Program 157 Three Main Subcortical Brain Regions: 3. Nucleus Accumbens - located in forebrain and part of basal ganglia. – Reward center of brain which is activated in anticipation of reward. – Most recreational drugs including cocaine and amphetamines increase dopamine in this area. – Involved in task motivation and rewards. 158 Copyright (C) KIDS, Inc. 79 School Neuropsychology Post-Graduate Certification Program 159 160 Copyright (C) KIDS, Inc. 80 School Neuropsychology Post-Graduate Certification Program Three Main Cortical Brain Regions: 1. Orbitofrontal cortex - region of the brain responsible for ascribing an emotional valence or value judgment to another’s feelings. Often triggers an automatic social skills response (Rolls, 2004) Has rich interconnections with the limbic system. 2. Ventrolateral prefrontal cortex – responsible for response inhibition and emotional regulation. 3. Anterior Cingulate Cortex - motivation and reward based decision making. Key brain region in developing “theory of mind”. 161 • Lezak, M. D. (2004). Neuropsychological Assessment (4th Ed.). New York: Oxford University Press. • Teeter, P. A. and Semrud-Clikeman, M. (1997). Child Neuropsychology: Assessment and Interventions for Neurodevelopmental Disorders. Boston: Allyn and Bacon. 162 Copyright (C) KIDS, Inc. 81