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Another unit of angular measure sometimes used in biomechanical analyses is the radian. A line connecting the center of a circle to any point on the circumference of the circle is a radius. Because a radian is much larger than a degree, it is a more convenient unit for the representation of extremely large angular distances or displacements. The third unit sometimes used to quantify angular distance or displacement is the revolution. Dives and some gymnastic skills are often described by the number of revolutions the human body undergoes during their execution. Figure 11-9 illustrates the way in which degrees, radians, and revolutions compare as units of angular measure. Angular Speed and Velocity Angular speed is a scalar quantity and is defined as the angular distance covered divided by the time interval over which the motion occurred: angular speed 5 s5 angular distance change in time f ўt the lowercase Greek letter sigma represents angular speed, the lowercase Greek letter phi represents angular distance, and t represents time. Units of angular speed and angular velocity are units of angular distance or angular displacement divided by units of time. Units of angular speed and angular velocity are degrees per second (deg/s), radians per second (rad/s), revolutions per second (rev/s), and revolutions per minute (rpm). Moving the body segments at a high rate of angular velocity is a characteristic of skilled performance in many sports. Angular velocities at the joints of the throwing arm in Major League Baseball pitchers have been reported to reach 2320 deg/s in elbow extension and 7240 deg/s in internal shoulder rotation (3). Interestingly, these values are also high in the throwing arms of youth pitchers, with 2230 deg/s in elbow extension and 6900 deg/s in internal rotation documented (3). What does change as pitchers advance to higher and higher levels of competition is that they tend to become more consistent with the kinematics of their pitching motions (4). However, this does not translate to better coordination or decreased risk of overuse injury (4). Comparison of different types of pitches thrown by collegiate baseball pitchers showed internal shoulder rotation values of 7550 deg/s for fastballs, 6680 deg/s for change-ups, 7120 deg/s for curveballs, and 7920 deg/s for sliders (2). A study of world-class male and female tennis players has documented a sequential rotation of segmental rotations. Analysis of the cocked, preparatory position showed the elbow flexed to an average of 104° and the upper arm rotated to about 172° of external rotation at the shoulder. Angular velocity of the racquet during serves executed by professional male tennis players has been found to range from 1900 to 2200 deg/s (33. As discussed in Chapter 10, when the human body becomes a projectile during the execution of a jump, the height of the jump determines the amount of time the body is in the air. Angular Acceleration angular acceleration rate of change in angular velocity Angular acceleration is the rate of change in angular velocity, or the change in angular velocity occurring over a given time. What is the angular velocity of the club when it strikes the ball at the end of a 0. Just as with linear acceleration, angular acceleration may be positive, negative, or zero. Just as with linear acceleration, positive angular acceleration may indicate either increasing angular velocity in the positive direction or decreasing angular velocity in the negative direction. Similarly, a negative value of angular acceleration may represent either decreasing angular velocity in the positive direction or increasing angular velocity in the negative direction. Units of angular acceleration are units of angular velocity divided by units of time. Common examples are degrees per second squared (deg/s2), radians per second squared (rad/s2), and revolutions per second squared (rev/s2). Angular Motion Vectors Because representing angular quantities using symbols such as curved arrows would be impractical, angular quantities are represented with conventional straight vectors, using what is called the right hand rule. According to this rule, when the fingers of the right hand are curled in the direction of an angular motion, the vector used to represent the motion is oriented perpendicular to the plane of rotation, in the direction the extended thumb points (Figure 11-14). For this relationship to be valid, two conditions must be met: (a) the linear distance and the radius of rotation must be quantified in the same units of length, and (b) angular distance must be expressed in radians.
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The exact role of the various reflex components in stiffness regulation in fast human movements in sport remains to be fully established as do their effects in the stretchshortening cycle (see below). It is clear, however, that the reflexes can almost double the stiffness of the muscles alone at some joints. Furthermore, muscle and reflex properties and the central nervous system interact in determining how stiffness affects the control of movement. The mechanisms thought to be involved are pre-load, elastic energy storage and release (mostly in tendon), and reflex potentiation. The stretchshortening effect has not been accurately measured or fully explained. It is important not only in research but also in strength and power training for athletic activities. Some evidence shows that muscle fibres may shorten while the whole muscletendon unit lengthens. Furthermore, the velocity of recoil of the tendon during the shortening phase may be such that the velocity of the muscle fibres is less than that of the muscletendon unit. These interactions between tendinous structures and muscle fibres may substantially affect elastic and reflex potentiation in the stretchshortening cycle, whether or not they bring the muscle fibres closer to their optimal length and velocity. There have been alternative explanations for the phenomenon of the stretchshortening cycle. Differences of opinion also exist on the amount of elastic energy that can be stored and its value in achieving maximal performance. The creation of larger muscle forces in, for example, a counter-movement jump compared with a squat jump is probably important both in terms of the pre-load effect and in increasing the elastic energy stored in tendon. Muscle force components and the angle of pull In general, the overall force exerted by a muscle on a bone can be resolved into three force components, as shown in Figure 6. Joint stabilisation is an important function of muscle force, particularly for shunt muscles (see below). The relative importance of the last two components of muscle force is determined by the angle of pull ; this is illustrated for the brachialis acting at the elbow in Figure 6. Spurt muscles are muscles for which p > 1; the origin is further from the joint than is the insertion. Shunt muscles, by contrast, have p < 1 because the origin is nearer the joint than is the insertion. Even for rotations well away from the reference position, the angle of pull is always small. The force is, therefore, directed mostly along the bone so that these muscles act mainly to provide a stabilising rather than a rotating force. Such muscles may also provide the centripetal force, which is largely directed along the longitudinal axis of the bone towards the joint, for fast movements. Two-joint muscles are usually spurt muscles at one joint, as for the long head of biceps brachii acting at the elbow, and shunt muscles for the other joint, as for the long head of biceps brachii acting at the shoulder. Within the human musculoskeletal system, anatomical pulleys serve to change the direction in which a force acts by applying it at a different angle and, sometimes, achieving an altered line of movement. This muscle runs down the lateral aspect of the calf and passes around the lateral malleolus of the fibula to a notch in the cuboid bone of the foot. It then turns under the foot to insert into the medial cuneiform bone and the first metatarsal bone. The pulley action of the lateral malleolus and the cuboid accomplishes two changes of direction. The result is that contraction of this muscle plantar flexes the foot about the ankle joint (among other actions). The magnitude and direction of the muscle force vector (F) have been kept constant through figures (a) to (f). An anatomical pulley may also provide a greater angle of pull, thus increasing the turning component of the muscle force. The patella achieves this effect for quadriceps femoris, improving the effectiveness of this muscle as an extensor of the knee joint.
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One problem is that most of the studies were small and heterogeneous with regard to the patients and methods. This is especially true for comparing any technique with sham or placebo treatment. For manual therapy, central trigger points are treated by stretching the muscle because this inactivates it. Trigger points lying in the attachment of the muscle to the bone are treated using direct manual therapy. Other well-known techniques such as biofeedback and neuromuscular stimulation have been used in the treatment of trigger points. There is no evidence that manual techniques are more effective than no treatment (22). Different systematic reviews have come to the conclusion that, although there is an effect of needling on pain, it is neither supported nor refuted that this effect is better than placebo (23). Other reviews have concluded that the same is true for the difference between dry and wet needling (24,25). It is more expensive than lidocaine and has not been proven to be more effective (26). The magnitude of reduction was significantly higher than that in the placebo group. Relaxation of the urethral sphincter alleviates the bladder problems and secondarily the spasm. The therapeutic options for physiotherapists may not be the same in every country. Physiotherapists can either specifically treat the pathology of the pelvic floor muscles, or more generally treat myofascial pain if it is part of the pelvic pain syndrome. Overactivity of the pelvic floor muscles is related to chronic pelvic pain, prostate, bladder and vulvar pain. Biofeedback improves the outcome of myofascial therapy for pelvic floor dysfunction. Trigger point release is effective in treating muscle and referred pain, but there is no preference from one method over another. In patients with chronic pelvic pain syndrome it is recommended to apply pelvic floor muscle treatment as first line treatment. In patients with an overactive pelvic floor biofeedback is recommended as therapy adjuvant to muscle exercises. When myofascial trigger points are found treatment by pressure or needling is recommended. Standardisation of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Muscle tenderness in Men with Chronic Prostatitis/Chronic Pelvic Pain syndrome: the Chronic Prostatitis Cohort Study. Biofeedback Is Superior to Electrogalvanic Stimulation and Massage for Treatment of Levator Ani Syndrome. Similarity of distributions of spinal C-fos and plasma extravasation after acute chemical irritation of the bladder and the prostate. Face validity and reliability of the first digital assessment scheme of pelvic floor muscle function conform the new standardized terminology of the International Continence Society. Simple test of pelvic muscle contraction during pelvic examination: correlation to surface electromyography. Test Retest Reliability of Anal Pressure Measurements in Men with Erectile Dysfunction. Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. Systematic review of randomized controlled trials of the effectiveness of biofeedback for pelvic floor dysfunction. Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review.
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Pain assessment tools may not provide sufficient information to guide interventions. Investigate other aspects of the pain in order to provide more effective, individualized interventions. Assess for deterioration of the ulcer or possible infection when the individual reports increasing intensity of pain over time. Use a lift or transfer sheet to minimize friction and/or shear when repositioning an individual, keeping bed linens smooth and unwrinkled. Organize care delivery to ensure that it is coordinated with pain medication administration and that minimal interruptions follow. Reduce pressure ulcer pain by keeping the wound bed covered and moist, and using a non-adherent dressing. Where available, consider ibuprofen impregnated wound dressings as a topical analgesic treatment for pressure ulcer pain. Consider the use of non-pharmacological pain management strategies to reduce pain associated with pressure ulcers. Administer pain medication regularly, in the appropriate dose, to control chronic pain following the World Health Organization Pain Dosing Ladder. Use adequate pain control measures, including additional dosing, prior to commencing wound care procedures. Consider using topical opioids (diamorphine or benzydamine 3%) to reduce or eliminate pressure ulcer pain. Local itching and irritation has been reported, but not more frequently than when a placebo gel is applied. Refer the individual with chronic pain related to pressure ulceration to the appropriate pain and/or wound clinic resources. Work with the multi-disciplinary health care team to develop a holistic plan to manage chronic pressure ulcer pain. Educate the individual, caregivers, and health care providers about causes, assessment and management of pressure ulcer pain. Apply cleansing solution with sufficient pressure to cleanse the wound without damaging tissue or driving bacteria into the wound. Contain and properly dispose of used irrigation solution to reduce cross-contamination. Select the debridement method(s) most appropriate to the individual, the wound bed, and the clinical setting. Use mechanical, autolytic, enzymatic, and/or biological methods of debridement when there is no urgent clinical need for drainage or removal of devitalized tissue. Surgical/sharp debridement is recommended in the presence of extensive necrosis, advancing cellulitis, crepitus, fluctuance, and/or sepsis secondary to ulcer-related infection. Conservative sharp debridement and surgical/sharp debridement must be performed by specially trained, competent, qualified, and licensed health professionals consistent with local legal and regulatory statutes. Use conservative sharp debridement with caution in the presence of: immune incompetence, compromised vascular supply, or lack of antibacterial coverage in systemic sepsis (Strength of Evidence = C; Strength of Recommendation =). Caution: Relative contraindications include anticoagulant therapy and bleeding disorders. Perform a thorough vascular assessment prior to debridement of lower extremity pressure ulcers to determine whether arterial status/supply is sufficient to support healing of the debrided wound. Assess stable, hard, dry eschar at each wound dressing change and as clinically indicated. Clinical indications that the dry, stable eschar requires assessment and intervention include signs of erythema, tenderness, edema, purulence, fluctuance, crepitus, and/or malodor. Consult a medical practitioner/vascular surgeon urgently in the presence of the above symptoms. Perform maintenance debridement on a pressure ulcer until the wound bed is free of devitalized tissue and covered with granulation tissue. When the primary defense provided by intact skin is lost, bacteria will reside on the wound surface. When the bacteria (by numbers or virulence in relation to host resistance) cause damage to the body, infection is present. Follow local infection control policies to prevent self-contamination and cross-contamination in individuals with pressure ulcers. Have a high index of suspicion of local infection in a pressure ulcer in the presence of: lack of signs of healing for two weeks; friable granulation tissue; malodor; increased pain in the ulcer; increased heat in the tissue around the ulcer; increased drainage from the wound; an ominous change in the nature of the wound drainage.
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Rheumatology is a subspecialty of internal medicine dealing with bone and joint diseases (connective tissue and related tissue disorders of bone, cartilage, tendons, ligaments, tendon sheets, bursae, muscles, etc. Although modern rheumatology is based on advanced molecular biology, immunology, and immunogenetics, the daily practice and routine diagnosis is mainly clinical and based on symptoms and signs. In the majority of cases, laboratory tests and imaging have a confirmatory role, instead of being mandatory. Bone diseases are divided into metabolic (osteoporosis, osteomalacia), infectious, tumoral (benign, malignant, metastatic), and genotypic malformations. Inflammatory pain occurs during rest and disappears or improves gradually with activity. It is accompanied by some degree of stiffness, especially in the morning when the patient wakes up. Mechanical pain appears with activity, increases gradually, and disappears with rest. It can be accompanied by gelling pain, which resembles inflammatory pain, but is of very short duration (a few minutes or less). Pure continuous pain is rare; usually one can find an inflammatory or mechanical feature. Abnormal movement is an indicator of joint dislocation (cartilage destruction, ligament tear, and epiphyseal collapse). Articular manifestations can be divided into six categories: inflammatory, mechanical, metabolic, neurological, infectious, and tumoral disorders. Extra-articular manifestations are also called soft tissue rheumatism (tendonitis, Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. The starting age depends mainly on the joint, with individual variation, which is probably due to variation in genetics. Plain X-ray is not necessary for the diagnosis, helping essentially to demonstrate the severity of cartilage destruction. The radiographic signs appear late (months or years after the onset) and are mainly joint space narrowing and osteophytes. Pain shows what activity is harmful to the joint and how much activity it can afford without interfering with the normal physiology of the cartilage. Pain-killing techniques are usually harmful for the joint, unless they are given concomitantly with rest. Explaining the physiology of pain is the best treatment for the prevention of fast degradation of the joint. They are given for 2 to 3 weeks (150 mg indomethacin or diclofenac, 15 mg prednisolone), along with moderate joint rest. After this period, medication is stopped, and the patient is advised about adequate joint activity. Exercise to improve muscle strength is very important, which by improving joint physiology helps to slow down the disease process. The characteristics of each joint, the chronology of the symptoms, the number and location of involved joints, and the pattern of involvement are usually enough to suspect a diagnosis, or better, to make a diagnosis. In many cases (soft-tissue rheumatisms, low back pain, or mechanical cervical pain), no laboratory investigation is necessary. Although treatment has made great advances in the last decade (biological agents, sophisticated immune modulators, etc. The majority of low back pain will respond well to a few days of rest and anti-inflammatory drugs. After resting, patients have to be taught how to strengthen their musculature with adequate exercises and must be advised about maintaining daily activities. The same is true for cervical pain, osteoarthritis, and many of the soft-tissue rheumatisms. It is a false idea that mechanical pain, like osteoarthritis, needs analgesics or anti-inflammatory drugs for a long time or forever. Continuous use of analgesics will lead to more cartilage damage in the joint, while correct use of the joint will help to arrest or slow down the cartilage degradation. New therapies, mainly biological agents, have changed the outcome of crippling rheumatic disease.
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When clinical information is combined with analysis of animal data about potential teratogenic or carcinogenic effects, or data about how much drug is transferred into the breast milk, the level of concern about a drug can be estimated. Consequently, regulatory bodies and educational organizations in many countries have classified drugs into risk categories that are used to guide a risk versus benefit assessment in the pregnant and lactating woman. For example, there is no evidence that opioids are risky in early pregnancy, but they may cause depression of the neonate at birth, so most opioids are classified as drugs that have harmful but reversible pharmacological effects on the human fetus or neonate, without causing malformations. It is imperative to relieve maternal suffering, but at the same time, harm to the fetus should be avoided. It is important that we know where to look and are able to access information about these topics when specific information is required. Author(s) anesthetist or pain specialist, a physiotherapist, a chiropractor, a psychologist, a pharmacist, and/or a community nurse. This multidisciplinary team approach will optimize her care, and regular review of her pain management can be organized. Shillah may well have physical and psychological factors contributing to her pain that can be treated in various ways, including physical therapies and even invasive pain therapy procedures or surgery, such that her reliance on drugs might be reduced or even eliminated. The latter would, of course, solve all the issues related to the potential pharmacological toxicities of drugs administered during pregnancy. Even if drug treatment remains the only way of controlling her pain, her response to the types of drugs, their doses, and the regimens prescribed will need to be reviewed once she becomes pregnant and as pregnancy advances. Shillah has chronic nonmalignant pain with neuropathic features, and you should refer to the chapters on back pain and neuropathic pain for information. You also need to be in a position to advise her about the specific risks of the drugs she is currently taking and about any risks associated with alternative drugs. Although there can be no guarantees of complete safety with any drug, and because controlling neuropathic pain can be challenging, it is not necessary for her to abandon all pain killers. Indeed, there is no evidence that continuing amitriptyline in early pregnancy significantly increases the risk of malformations. This is a drug many pregnant women have used, so the couple can be reassured of its relative safety, and it could be continued. Although these drugs do not cause fetal malformations, they adversely influence fertility, increase the risk of miscarriage by interfering with blastocyst implantation, and can cause serious problems in late What would be the ideal approach to pain management in pregnancy and lactation? During and immediately prior to pregnancy, nonpharmacological pain management options should be considered and explored before analgesic drugs are used. Ideally, if available in the regional city, and prior to Shillah becoming pregnant, she should be reviewed by a group of health care providers, particularly those with an interest in pain medicine and clinical experience dealing with patients with difficult pain management problems. You should advise Shillah to stop the diclofenac, and if available to try paracetamol (acetaminophen) instead, this being a much safer option. Although it is not ideal, there is no reason why Shillah should not continue to take codeine when she needs it (at a maximum dose of 240 mg per day), especially if you check her diet and advise her as to how to reduce her risk of constipation. Codeine has been used by many pregnant women and is considered safe for the fetus in early pregnancy. The main problem with codeine is that some people lack the liver enzyme required to demethylate it to its active metabolite, morphine, rendering it completely ineffective. Other people are ultrarapid codeine metabolizers and will experience higher plasma concentrations and more side effects (sedation, dysphoria, constipation, and neonatal depression), even after small to modest doses. After the period of organogenesis, limited data suggest that tramadol is probably of low risk to the fetus, although high dosing near delivery should be avoided (see case 3 below). In some countries, transdermal clonidine patches (100 g/day) are available, but clonidine is of questionable effectiveness, and despite extensive clinical use during pregnancy without evidence of causing congenital abnormalities, data on its safety in the first trimester are very limited. Good levels of evidence support both the efficacy and safety of typical doses of amitriptyline (initially 1025 mg orally at night). Ketamine, another potent analgesic, can be effective for both acute and neuropathic pain, although oral tablet or lozenge forms are still being developed. Ketamine has been used in large numbers of pregnant women without links to malformations, so it is considered safe, making it a valuable option when patients are admitted to hospital when either acute or neuropathic pain is difficult to manage(bolus up to 0.
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The longissimus dorsi muscle extends along the back and loins and also causes lateral flexion to the side of the unilateral contraction. Signs and Symptoms: When this muscle is tight, the horse shows soreness over the back when pressure such as saddling or grooming is put on it. During movement, the animal is very uncomfortable and will lose coordinated power. Its contraction causes lateral flexion of the trunk and assists in the extension of the back. Signs and Symptoms: When this muscle is tight and pressure is put on it, the horse shows soreness. Together with the internal oblique muscle, it aids in the contraction of the abdomen and assists in lateral bending. Signs and Symptoms: When this muscle is tight, the horse shows restricted lateral movement. If the stress point is very tender, the horse will flinch or try to pull away from the pressure and eventually raise his hind leg. Together with the internal oblique muscle it aids in the contraction of the abdomen and assists in lateral bending. Signs and Symptoms: When this muscle is tight, the horse shows general discomfort and restricted lateral movement. Stress point 23 will be felt as a tight, thick muscle knot at the area where the tenth rib attaches to the sternum. Body Parts and Their Stress Points 217 #24 Stress Point-The Internal Abdominal Oblique Muscle Myology: the internal abdominal oblique muscle (located in the deep layer) attaches to the anterior aspect of the hip and runs downwards to anchor on the ribs. With the external abdominal oblique muscle, it aids in the contraction of the abdomen and assists in lateral bending. Stress point 24 will be felt as a tight, thickened ridge in the middle of the muscle, a couple of inches below the origin attachment. Its contraction aids in the contraction of the abdomen and assists in lateral bending. Signs and Symptoms: When this muscle is tight, the horse shows general discomfort and a shorter stride in the hind legs. If the stress point is very tender, the horse will flinch; he might stamp his hind foot on the same side or try to pull away from the pressure. Stress point 25 will be felt as a tight, thickened muscle a few inches in front of the point of the hip. Stress point 26 will be felt as a tight muscle knot between the tenth and eleventh ribs. The whole intercostal muscle might show tightness all around the rib cage, depending on the severity of the stress. There are breed-specific variations in the natural angles formed by the joints of the hind legs. The more angle at the joints (sloping pelvis, angular stifle and hock), the greater the predisposition for sprinting or jumping. The straighter the joint (nearly horizontal pelvis, straight stifle and hock), the greater the predisposition for a long stride; for example, the stride of a racehorse (the longer the muscle, the more ground covered with each stride). The bony areas of the hindquarters that can be palpated are: the point of croup (ilium); point of buttock (ischium), point of hip (femur), and stifle joint (femur, tibia, and patella). The bulky muscles of the hindquarters anchor on the lumbar spine and the pelvis; they run downward and attach to the femur and tibia of the hind leg. Follow each training session with a thorough stretching Body Parts and Their Stress Points 219 10. Thoroughly massage the hindquarters, emphasizing drainage, and check all main stress points. The longissimus dorsi muscle (located in the deep layer) runs along the spine from the withers to the point of croup, attaching onto the thoracic vertebrae and the ribs and inserting on the lumbar vertebrae.
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The cranial nerve conveys sensations from the retina of the eye to the thalamus. Sympathetic postganglionic fibers innervating these effectors secrete acetylcholine (are cholinergic). Therefore, blocking the muscarinic receptors would cause an increase in the resting heart rate. False; the abducens, oculomotor, and trochlear cranial nerves innervate muscles that move the eye. Sensory organs are specialized extensions of the nervous system that contain sensory (afferent) rvey neurons adapted to respond to specific stimuli and conduct nerve impulses to the brain. Because sensory organs are very specific as to the stimuli to which they respond, they act as energy filters that allow perception of only a narrow range of energy. For example, the rods and cones within the eye respond to a precise range of light waves and normally do not respond to x-rays, radio waves, or ultraviolet and infrared light. The senses of the body are classified as general senses or special senses according to the complexity of the receptors and the neural pathways (nerves and tracts) involved. General senses include the cutaneous receptors (touch, pressure, heat, cold, and pain) within the skin. Collectively, the cutaneous receptors are said to provide the sense of touch (see problem 5. Special senses are localized in complex receptor organs and have extensive neural pathways. These receptors require a moist environment, as the sensed chemicals must dissolve into the fluid covering the receptor. Photoreceptors are specialized neurons that respond to light waves of varying energy. Mechanoreceptors are specialized neurons that respond to the physical distortion of the receptor membrane. Mechanoreceptors are important for touch and pressure sensation, as well as for hearing and balance. Thermoreceptors are specialized neurons that depolarize in response to changes in temperature. Most thermoreceptors respond to relative changes in temperature and not to absolute temperature. Objective B Su To describe the receptors and the neural pathway for the sense of taste. Receptors for the sense of taste (gustation) are located in taste buds on the surface of the tongue. A few taste buds are also located in the mucous membranes of the palate and pharynx. A taste bud contains a cluster of 40 to 60 gustatory cells, as well as many more supporting cells (fig. The four primary taste sensations are sweet (evoked by sugars, glycols, and aldehydes), sour (evoked by H, which is why all acids taste sour), bitter (evoked by alkaloids), and salty (evoked by anions of ionizable salts). The largest but fewest in number, they are arranged in an inverted V-shaped pattern on the back of the tongue (see fig. Short and thickened in appearance, they are found on the anterior two thirds of the tongue. With continuous exposure to a taste stimulus, there is a decrease in sensory neuron transmission. Sensory innervation of the tongue and pharynx is by the chorda tympani branch of the facial nerve from the anterior two thirds of the tongue, the glossopharyngeal nerve from the posterior third of the tongue, and the vagus nerve from the pharyngeal region (see table 11. Taste sensations are transmitted to the brainstem (nucleus solitarius), then to the thalamus (nucleus ventralis posteromedialis), and finally to the sensory cerebral cortex (postcentral gyrus on the lateral convexity), where taste perception occurs (fig. Objective C Su To identify the receptors and neural pathway for the sense of smell.