Biomedical Signal Processing

Unit II
Cardio Vascular and Nervous
System

Edited By : Nishikant Surwade

Biomedical Signal Processing

2.1 Cardio Vascular System: Cardiovascular system, Coronary

and Peripheral Circulation

Edited By : Nishikant Surwade

 H an db o ok of B iome dic al ln s tr um ent at ion

Pathophysiology relates to the pathological (study or symptoms of disease) functions

of the organs.
In addition, ciassification into various sub-areas dealing with diff€rent organs
can be made.
For exampie:
Circulatory physiology is the study of blood circulation relating to functioning of the
heart.
Respiratory physiology deals with the functioning of breathing organs.

iiiiiD 1.2 PHYSIOTOCICAL SYSTIMS OF THE BODY

Humanbody is a complex engineering marvel, which contains various types of systems such as
electrical, mechanical, hydraulic, pneumatic, chemical and thermal etc. These systerns
communicate
internally with each other and also with an external environment. By means of a multi-level
control system and communications network, the individual systems enable the humanbody
to
perform useful tasks, sustain life and reproduce itself.
Although, the coverage of detailed information on the physiological systems is outside the
scope of this book, nevertheless a brief description of the malor sub-s"ysterns
of the body is given
below to illustrate the engineering aspects of ihe human body.

1.2.1 The Cardiovascular System

The cardiovascular system is a complex closed hydraulic system, which performs

the essential
servic-e of transportation of oxygen, carbon dioxide, numerous chemical
compounds and the blood
cells. Structurally, the heart is divided into right and left parts. Each part has two
chambers called
atrium and ventricle. The heart has four valves (Fig. 1.1):
o The Tricuspid valve or right atrio-ventricular valve-between right atrium and
venkicle. It
consists of three flaps or cusps. It prevents backward flow of blood from right ventricle to1\'arc
to
rightatrium. smal-i d
' Bicuspid Mitral or left atrio-ventricular valve-between left atrium and left ventricle. estirnal
The valve has two flaps or cusps. It prevents backward flow of blood from left veir*rc,'!
ventricle to
atrium. Fror
' Pulmonary valve-at the right ventricle. it consists of three ha,f moon shaped cusps. This of the c
does not allow blood to come back to the right ventricle. timesp
o Aortic valve-between left ventricle and aorta. Its construction is like pulmonary The pu
valve.
This valve prevents the return of blood back to the left ventricle from aorta. each pr
The heart wall consists of three layers: (1)Thepericardium,which is the stage i I
outer layer of the heart.
It keeps the outer surface moist and prevents friction as the heart beats. (ii) Themyocardium to the h
is gne
middle layer of the heart. It is the main muscle of the heart, which is made up of s"hort cylindrical In tt!
fibres. This muscle is automatic in action, contracting and relaxing rythmically throughout througJ
life.
(iii) The endocardiumis the inner layer of the heart. It provides smoJthiini.,g The art
rorine utoJa to flon,.
The blood is carried to the various parts of the body through blood vessels, In sr
which are hollon,
tubes. There are three types of blood vessels. (1) Arteries-aie thick walled The blc
and they carry the
oxygenated blood away from the heart. (ii)Veins-are thin walled and carry de-oxygenated its bran
blood
 F undamentals of Medical lnstrumentation

eorgans. Superior vena cava

re made.

irL '*o
o

\
Right atrium Aortic valve
s such as
nunicate
rlti-level Mitral valve
rbody to

Eide the
is given

Left ventricle

ssential
heblood Myocardium
rs called Tricuspid valve

> Fig. 1 .1 Structure of the heart

rtricle. It
ttricle to towards the heart. (nr)Capillaries-are the smallest and the last level of blood vessels. They are so
small that the blood cells, which make blood, actually flow one at a time through them. There are
entncle. estimated to be over 800,000 km of capillaries in human being, which include all the arteries and
fricle to veins, which carn' blood.
From an engineering point of view, the heart which drives the blood through the blood vessels
ps. This of the circulatorv svstem (Fig. 1.2) consists of four chamber muscular pump that beats aboutT2
times per minute (on an average for a normal adult), sending blood through every part of the body.
y valve. The pump acts as two slmchronized but functionally isolated two stage pumps. The first stage of
each pump (the atrium) collects blood from the hydraulic system and pumps it into the second
stage ( the vmtride). in this process, the heart pumps the blood through the pulmonary circulation
cheart.
to the lungs and through the systemic circulation to the other parts of the body.
rn is the
hr the pulmonary circulation, the venous (de-oxygenated) blood flows from the right ventricle,
indrical
through the pulmonary artery, to the lungs, where it is oxygenated and gives off carbon dioxide.
out life.
The arterial (oxygenated) blood then flows through the pulmonary veins to the left airium.
toflow.
In systemic circulation, the blood is forced through blood vessels, which are somewhat elastic.
lrollow
The blood flows from the left atrium to the left ventricle and is pumped through the aorta and
trn-the
its branches, the arteries, out into the body. Through the arterioles (small arteries), the blood is
dblood
 Handbook of Biomedical lnstrumentation

::,::r@
;rn:firi;N
ntc,,g
Ef,M
]F{
mltril fi
usm!fir
-O^ ?!mEm
COZ Lung ::rrmdm
_.-

Semilunar
Location of tJ-l
sinus node Left atrium
valve
lh*:ery
Right atrium Aortic valve SStrifM?
Tricuspid Jt -l-a'4
valve Mitral valve
Right ventricle
it€ :mm
Left ventricle

Legs

> Fig. 1"t The Circulatory systeffi

distributed to the capillaries in the tissues, where it gives up its oxygen and chemical compounds,
takes up carbon dioxide and products of combustion.
The blood returns to the heart along different routes from different parts of the body. It usualil,
passes from the venous side of the capillaries directly via the venous system to either the superior
vena cava or the inferior vena cava, both of which empty into the right atrium. The heart itself is
supplied by two small but highly important arteries, the coronary arteries. They branch from the
aorta just above the heart. If they are blocked by coronary thrombosis, myocardial infarction
follows, often leading to a fatal situation.
The heart rate is partly controlled by autonomic nervous system and partlyby harmone action.
These control the heart pump's speed, efficiency and the fluid flow pattern through the system.
The circulatory systern is the transport system of the body by which food, oxygen, water and
other essentials are transported to the tissue cells and their waste products are transported awav.
This happens through a diffusion process in which nourishment from the blood cell diffuses
 lllllI

F undamentals of Medical lnstrumentation

through the capillary wall into interstitial fluid. Similarly, carbon dioxide and some waste
produ-cts from the interstitial fluid diffuses through the capillary wall into theblood cell.
The condition of the cardiovascular system is examined by haemodynamic measurements and
by recording the electrical activitv of the heart muscle (electrocardiography) and listening to the
heart sounds (phonocardiography). For assessing the performance of the heart as a PumP/
measurement of the cardiac output (amount of blood pumped by the heart per unit time), blood
pressure, blood flow, rate and blood volume are made at various locations throughout the
circulatory system.

1.2.2 The Respiratory System

The respiratory system in the human body (Fig. 1.3) is a pneumatic system in which-an air Pump
(diaphragm) altemately creates negative and positive pressures in a sealed chamber (thoracic
cavi?y) ,id .urr", air to be sucked into and forced out of a pair of elastic bags (lungs). The lungs
are connected to the outside environment through a passage way comprising nasal cavities,

Pharynx
(throat)

Larynx

Trachea
windpipe
(air passage)

Bronchiole
(smallest air
passage)

mrPounds,
Pleura
p.It usually
hesuperior
eart itself is
dr from the
I infarction Alveoli '
(brarrch from bronchiole
where exchange occurs)
ureaction.
Diaphragm
Esystem.
,water and
rhdaway.
dl diffus€s > Fig.1.3 TheRespiratory system
Biomedical Signal Processing

2.2 Electrical Activity of the heart, Lead configurations ,

ECG data acquisition, ECG recorder

Edited By : Nishikant Surwade

 tr
=ele..-tetd
:r.t:uttgd
i'r:wc
::cs'r dlee
:rlad up
eHnprsn :rrapush'
r:ean'tph
5 slsrlai res
rri.le fxlr
"'rf
.-rr: th"r Fia
rirmtai h
:arnplrg
;al:bratit
Biomedical Recorders ,eaj =rt-i'l

.. ]} $"-! ILECTROCARDIOGRAPH
records the eiectrical activity of the hear.
Tire electrr:cardiograph (ECG) is an instrument, which
signals from the heart characteristically prececle the
normal mechanical function and
Electrical
ECC provides valuable information
monitoring of these ,ignut, has great clinical significance'
ii-r" po"t"t of an inactive pari (infarction) or an
alrout a r.vide range of Jardiac dis"orders such as
""
Electrocardiographs are used in catheteriza-
mrlargement 1cur,lluc hifeitrophy) of the heart muscle'
ancl for routine diagnostic applications in cardiology'
tion lal:oratoriur, .o.oirlry
"rie.rnits by the heart can be best characterized by vector quantities'
although the eiectric field generated
quantities' i'e' a voltage difference of m\'
it is generally convenient to directly measure only scalar
useful frequency range is usualh'
*rderbetween the gi'en points of inemay' TIr" diagnostically -d'$
accepteci as (').05 to i 50 liz (Golden et al 1'973).The
implifier and writing part should faithfullr' :le st]-
reprociuce signals in this range. A good low frequen.y
i"'po"'" is essential to ensure stability of ot"erat
of several factors like isolati.n between a
the basetrine. High frequency"rerpo:nr" is a compromise Ela
(myographic potentials) and limitations
use{ul ECG signrl rroJ1 othJ, signals of biologiial origin -nes a
and friction' The interference of non-
of tire tlirect writing p"r, ,u"ori"rs due to riass, inertia il€agJ
amplifiers' which are capable oi
biologicai origin .ur, iu handled by usingmodern differential :eccrd
order of L00-120 dB with 5 kO unbalance
providing excellent."i"J.".rp"uiryillcrvrRRof the i6dt
In addition to this, under specially adverse
in ihe leads is a desirable feature of ECG machines.
circumstances, it becomes necessary to include a
notch filter tuned to 50 Hz to reject hum due l*ld
from the changes of the contact ei*tn
to power mains. rrre inJaUility oithe baseline, originating
impedance, demands the applicationof the automaticbaseline
stabilizing circuit' A minimum of anl'I
speecls ir rru."rru,.v (25 and 50 mm Per sec)
for ECG recording' ntct
twt paper
irllf*
-{ss
S.l.lBlockDiagramDescriptionofanElectrocardiosraph ',rfut
machine' The potentials picked up
Figure 5.1 shows the block diagram of an electrocardiograph
bi, ihe patient electrodes are tafe'r tc the leacl selector
u*it.h- In the lead selector, the etrectrodes are
 Biomedical Recorders 155

:elected twoby two according to the lead program. Bymeans of capacitive coupling, the signal is
connected symmetrically to the long-tail pair differential preamplifier. The preamplifier is usually
a three or four stage differential amplifier having a sufficiently large negative current feedback,
irom the end stage to the first stage, which gives a stabilizing effect. The amplified output signal is
picked up single-ended and is given to the power amplifier. The power amplifier is generally, of
the push-pull differentical type. The base of one input transistor of this amplifier is driven by the
preamplified unsymmetrical signal. The base of the other transistor is driven by the feeclback
signal resulting from the pen position and connected via frequency selective network The output
of the power amplifier is single-ended and is fed to the pen rr.otor, rvhich deflects the writing arm
on the paper. A direct rt'riting recorder is usually adequate since the ECG signal of interest has
limited bandwidth. Frequency selective network is an R-C network, u,hich provides necessary
damping of the pen motor and is preset by the manufacturer. The auxiliary circuits provide a 1 mV
calibration signal and automatic blocking of the amplifier during a change in the position of tire
lead switch. It may include a speed control circuit for the chart drive motor.

o
o
(,)
LlJ
!o
0)
5
roi tne neari.
ftur,:r-cn and Frequency
selective
' ini.- r::'.atlon feedback
lctr):] i Or an network
nca=eteriza-
;liolcc-,.
or quantihes,
erenie of m\' > Fig. $.t Block diagam of an ECG machine
ge is u,<uallr'
dd larthfullr- A 'stand by' mode of operation is generally provided on the electrocardiograph. In this mude,
re stallitr-of the stylus moves in response to input signals, but the paper is stationar.v. This mode allows the
mr beiir-een a operator to adjust the gain and baseline position controls without wasting paper.
d limitations Electrocardiograms are almost invariablv recorded on graph paper with horizontal and vertical
ence Lrf non- lines at 1 mm intervals with a thicker line at 5 mm intervals. Time measurements and heart rate
rc capable of measurements are made horizontally on the electi'ccardiogram. For routine work, the paper
Q unt,alance recording speed is 25 mm/s. Amplitude measurements are made vertically in millivoits. The
iallv adr-erse sensitivity of an electrocardiograph is typically set at 10 mm/mV.
rt hum due
lsolated Preamplifier:lthad been traditional for all electrocardiographs to have the right leg (RL)
I the contact
electrode connected to the chassis, and from there to the ground. This provided a ready path for
minrmumof
any ground seeking current through the patient and presented an electrical hazard. As the
microshock hazard became better understood, particularly when intracardiac catheters are
employed, the necessity of isolating the patient from the ground was stressed. The American Heart
Association guidelines state that the leakage current should notbe greater than 10 microamperes
tls picked up when measured from the patient's leads to the ground or through the main instrument grounding
{eckodes are
 155 Handbook of Biomedical I nstrumentat ion

wire with the ground oPen or intact. For this, patient leads would have
ground for all line operated units.
to be isolated from ttre ftF
[n-
Figure 5'2 shows a block diagram of an isolation preamplifier used in
cardiographs. Difference signals obtained from the right arm left arm (LA)
modern electru
and rig6t leg IRL r
n
1RA1,
is pven to a low-pass filter' Filtering is required on thJinput leadsto
C
electrosurgery and radio frequency emissions and sometimes from the 50 kHz
reduce interference caused tn- ht
respiration detection. The filter usually has a cut off frequency higher than
current
"rJf; bfl
filter is needed to achieve a suitable reduction in high frequency s"ignal.
10 kHz. A multistage L-
r u6Pl
P".f
wQr,
qSmJ

RA
LA
LL
RL lsolated power
transformer

> Fig. $.2 Blockiliagramof anisolationpreamplifier(transformeil_coupled)

commonly useil in modern ECG machines

The filter circuit is followed by high voltage and over voltage protection
circuits so that the
amplifier can withstand_large voltages during defibrillation. Hoirever, the
price of this protection
is a relatively high amplifier noise level arising from the high series
resistance in each lead.
The lead selector switch is used to derive the required lead configurations
and give it to a
dc-coupled amplifier. A dc level of 1 mV is obtained by dividing down-the
powu, ,rp"ply, which >F
can be given to this amplifier through a push button foicalibratiJn
of the amilifier. Isoiauon of the
patient circuit is obtained using a low capacitance transformer whose primary
winding is driven
from a 100 kHz oscillator. The transforrner second.ary is used to obtain an
of t5 V for operating the devices in the isolated portion of the circuit and
isolated power supply Ttrp
modulator at 100 kHz, which linearly modulates an ECG signal given to it. The
to drive the slzrchronous mflrl
oscillator frequency sEe"TeF
of 100 kHz is chosen as a compromise so that reasonable size transformers (higher
the frequency eefirrgdd
the smaller the transformer) could be used and that the switching
inexpensive transistors and logic circuitry can be utilized. A square
time is not too fast, so that ffrtrh
wave is utilized to minimize tuqmofu
 :_l
ii
li
ii
Biomedical Recorders "t57 i

Ed r:m:r &p the power requirements of the driven transistors.

A synchronous demodulator is chosen to give
lolv noise performance utilizing switching FET,s.
hm eisrc' Isolation of the patient preamplifier can also be_obtained
tightiea,Rl,,, using an optical isolator. The high
colrunon-mode rejection of the amplifier is obtained by proper
ecu-"eri Lry shielding. 'ihe effective capacitance
from the input leads to the earth is made negligible. Thepreamplifier
frrt u-<€d for circuitry should is preferablv
be shielded in a separate case"
\mufuL<aee
To minimize the common-mode signal between the body
of the patient and the floating ground,
a right leg drive circuit (Fig. 5'3) is used. The common-mode signals after
arnplificition in a
preamplifier are inverted and fed back to the right leg electrode,"reducing
the comrnon mcde
voltage on the input with respect to the floating gro"ia. Winter
and webi'ter (19s3) examine6
optimal design parameters for a driven-right-leg circuit.

Orfef,

I
eo that the
rlrotection
tlead.
trive it to a Common-mode rejectiofr mpiif ier
p\,u'hich > Fig. 5.S Imptooement in CMKR using ight
nirr of the leg drioe (Courtesy: Hewlett packard,
USA)
gisdriven
rcrsupplv
ldrronous ]heprlence of stray capacitance atthe input of thepreamplifiercausescorunon-mode currents
to flow in LA and RA, resulting in a voltage arop at ihe electrode resistors.
ftreguency An imbalance of the
stray capacitance or the electrode resistors causes a difference signal. This
frrequencv
difference signal can be
almost eliminated, in that the common-mode currents of stray-capacitances
sL so that are not allowed to
flow through the electrode resistors but are neutralized by currents delivered
rminimize to stray capacitances
from the common-mode rejection amplifier. In other words, the potentials
at A, B and C are
158 Handbook of Biomedical lnstrumentation

equalised through an in-phase component of the common-mode voltage, which the amplier
delivers via C, *a C, to LA and RA. As a result, the potentials at A, B and C are kept eou''
independent of the imbalance in the electrode resistors and stray capacitance.
The modern ECG machines with their completely shielded patient cable and lead u'ires a:r';
their high common-mode rejection, are sufficiently resistant to mains interference. However. tllee
could be locations where such interference cannot be eliminated by reapplying the electrods 'ar
moving the cable, instrument or patient. To overcome this problem, some ECG machines har-e ar
additional filter to sharply attenlate a narrow band centred at 50 Hz. The attenuation providei
could be up to 40 dB. In this way, the trace is cleaned up by the substantial reduction of iirc
frequency interference.
Isolation amplifiers are available in the modular form. One such amplifier is Model 274ttos
Analog Devices. This amplifier has the patient safety current as 1.2 pA at 115 V ac 60 Hz and ones
a noisJof 5 pV pp. It has u CUnn of 11rdB, differential input impedance of 1012 fl paralleled
rrif
3 pF ancl common mode impedance as 1011Q and a shunt capacitance of 20 pF' It is optimized ro:
signal frequencies in the range of 0.05 to 100 Hz. Metting van Riin ef al (1990) detail out methocs
for high-quality recording of bioelectric events with special reference to ECG.

5."1.2 The ECC Leads

Two electrodes placed over different areas of the heart and connected to the galvanometer n-ill
pick up the electiical currents resulting from the potential difference between them. For example,
if under one electrode a wave of L mV and under the second electrode a wave of 0.2 mV occur at the
same time, then the two electrodes will record the difference between them, i.e. a wave of 0.8 m\ '
The resulting tracing of voltage difference at any two sites due to electrical activity of the heart ts
called a"LE.LD" (Figs 5.4 (a)-(d)).
Bipolar Leads: In bipolar leads, ECG is recorded by using two electrodes such that the final frace
corresponds to the difference of electrical potentials existing between them. They are calied
standird leads and have been universally adopted. They are sometimes also referred to a-s
Einthoven leads (Fig. 5.4(a)).
In standard lead I, the electrodes are placed on the right and the left arm (RA and LA). In lead tr'
the electrodes are placed on the right arm and the left leg and in lead Iil, they are placed on the
left arm and the left leg. In all lead connections, the difference of potential measured betw'een
two electrodes is always with reference to a third point on the body. This reference point Ls
conventionally taken as the "right leg". The records are, therefore, made by using three eleckode:
at a time, the right leg connection being always present.
In defining the bipolar leads, Einthoven postulated that at any given instant of the cardiac
cycle, the electrical axis of the heart can be represented as a two dimensional vector. The ECG
measured from any of the three basic limb leads is a time-variant single-dimensional comPonent
of the vector. He proposed that the electric field of the heart couldbe rePresented diagrammaticallr'
as a triangle, with the heart ideally located at the centre. The triangle, known as the
"Einthoaat
triangle" ,is shown in Fig. 5.5. The sides of the triangle represent the lines along which the three
projections of the ECG vector are measured. It was shown that the instantaneous voltage measured
 il-

Biomedical Recorders
159
tangLtler
Bipolar Limb Leads
Ept equC

rires and
rTtr. tlwe
drrodes clr
shal'ean
prorided
m of line
C-M means'bommon mode,

Zl4frorn
rrd orters
ded rr-ith
tdzed tor
rrethods

&r n-ill
nample,
curat dre Unipolar limb leads
f0-8m\'.
aheart is

ml hace
E celled
cd to as

Llead tr,
ilcr the Lead AVR--
Lead AVF**
Etrt'een
point is
:todes

eardiac
be ECG
lrcnent
aticelly
frprcn (b)
rtfuee > Fig. S.4. Typ,es of lead connections with typical ECG waaefonns (a)
Bud bipotar
limb leads (b) unip orar rimb reaitsibourtesy : Hezabh p
ackard,
rrsA)
160 Handbook of Biomedical Instrumentation

(c) Unipolar chest leads

Vr' Fourth intercostal sPace'
at right sternal margin.
V^ Fourth intercostal spacB'
' at left sternal margin.
Vg Midway between V2 and V4.
V,- Fitth intercostal sPace' at
mid-calvicular line.
Vs Same level as V4, on anterior
axilliary line'
V6 Same level as V4, on mid
axilliary line.
E Ensiform, base of slemum'

CH positions

LEAD LEAD

o @
roEn
miEtr
irr'l

in eil
XS EE€d
t-@
f;ti-of[
changE
rgiet
:lgher1
LEAD LEAD o-f LtrIiP
m:rrrdc
@ @ mr-nesP
qbtair*
Ieadsar
1D

LEAD LEAD

@ @
{E-}

Fig. 5.4 Types of lead connections with typical EcG waoeforms (c) position
- oi'tt e ihest lead in unipolar precordial lead rccording u) c leads
(C o utt e sY : H ew I ett P a ck ar d, US A)
 Biomedical Recorders
161

> Fig. $.S The Einthoaen tiangle for itefining ECG leads
from any one of the three limb lead positions is approximately
equal to the algebraic sum of the
other two or that the vector sum of the projectioni on all
threeiines is equal to zero.
In all the bipolar lead positions, QRS of a normal heart is
such that the R wave is positive and
is greatest in lead II.
unipolat Leads (v Leads);The standard leads record the difference
in electrical potential between
two points on the body produced by the heart's action.
Quite oftery this vottage14,,itt show smaller
changes than either of the potentials and so better ,"r,Jtirrity
an be obtain"iif th" potential of a
single electrode is recorded. Moreover, if the electrode
is placed on the chest close to the heart,
higher potentials can be detected than normally available
at the timbs. This lead to the development
of unipolar leads introduced by wilson in rbg-+. In ,rrrr,j"*"r,t, the electrocardiogram is
recorded between a single exploratory electrode and_this
the centrfl terminal, which has a potential
corresponding to the centre of the body. In practice, the reference
electrode or central terminal is
obtained by a combination of several eiectrodes tied together at one point. Two
types of unipolar
Ieads are employed which are: (i) limb reads, and (ii)
piecordial reads.
(i) Limb leadsrnunipolar limb leads (Fig. 5.4@)), two of the limb leads
are tied together and
recorded with respect to the third hhb. In the lead identified
as AVR, *ru illit arm is
recorded with respect to a reference established by joining
the left arm and leit leg elec-
trodes' [:r the AVL lead, the left arm isrecorded with respecito
the common junction of the
right arm and left leg. In the AVF lead, the left leg is recorded
with respect to the two arm
electrodes fi ed together.
They are also called augmented leads or'averaging leads'.
The resistances inserted
between the electrodes-machine connections ure knowi as
'averaging resistances,.
(i) Precordial leadsThe second type of unipolar lead is a precordial
lead. It employs an explor-
ing electrode to record the potentiat or tne heart action on
the chest at slx different posi
oition tions' These leads are designated by the capital letter 'V'
followed by u ,rfr.ripi,,umeral,
bads which represents the position of the electiode on the
pericardium. rhe posiiions of the
chest leads are shown in Fig. 5.a(c).
Biomedical Signal Processing

2.3 Blood Pressure Measurement

Edited By : Nishikant Surwade

 256 CHAPTERg

(i.e., a gravitational force) exactly balances the If the valve is open to atmosphere, then thc
force of the atmospheric pressure. Torricelli found pressure on the mercury in the chamber is equal b
that the height of the mercury column that can be the pressure on the column (i.e., I atm). The rner-
supported by atmospheric pressure is approxi- cury in the column will have the same height ar
mately 0.76 m, or 760 mm. Atmospheric pressure, the mercury in the chamber, and this point is des.
then, is frcquently given in units of millimeters of ignated as a pressure of 0 mm Hg. If the valve h
mercury and I atm is 760 mm Hg.t closed, and the pressurc inside of the chamber ir
The pmper unit of pressure, as established by increasedby operating the pump, then the mercury
scientists and adopted by the National Bureau ol in the column will nse an amount pmportiorul b
Standards, is the torr (after Torricelli), in which I the increased pressure.
torr is equal to I mm Hg (l torr : I mm Hg).t
Gauge prcssures are usually given in millime- Example 9-3
ters of mercury above or below atmospheric pres-
The mercury in a manometer, such as the one ir
surc. A manomet€r is any device that measures
Figurc 9-2b, rises to a height of 120 mm Hg. Frnd
gauge pressure, although in commonly accepted
(a) the gauge pressure and (b) the absolute pressurE
jargon, gauge pressures below I atm are said to be
measured onavacuum gauge, and pressures above Solution
I atm are said to be measured onapressure gauge. (a) 120 mm Hg (by definition)
Both instruments are, however, examples of
manometers. Some manometers, including most of (b) 120 mm Hg * 760 mm Hg : 880 mm Hg
the electronic instruments discussed in this chap-
ter, measurc both positive pressures (i.e., above I We use gauge pressure because it is more easily
atm) and negative pressures (i.e., vacuums). referenced at zero and can be easily recalibrated *
Tlte zeru rcference in gauge pressure measure- each use, and the absolute pressure confers no spe-
ments, therefore, is a pressure of atm. Even I cial advantage as to information content. The vari-
though atmospheric pressure varies from one ation of atmospheric prcssure from one location to
place to another, and in the same location over the another (dependent upon mean sea level) and o\E
course of a few hours, zero can be established at the course of a single day makes the use of gauge
each measurement by setting the zero scale with pressures more advantageous,
the manometer open to atmospheric pressure. Fig-
urc 9-2b shows a mercury manometer similar to
those used to make blood pressure measurements. 9-6 Blood pnessure measurcments
The open tube is connected to a mercury reservoir The earliest recorded attempt at the measurcBd
that is fitted with a rubber squeeze-ball pump that of arterial blood pressure was performed in 1773 by
can be used to increase pressure; a valve is used English scientist Stephen Hales, who used an op*
to either open the chamber to atmosphere or close ended tube inserted directly into an artery in tlE
it off. neck of an rnanesthetized horse (presumably ticd
down securely). The tube was long enough thr
blood rose to a height at which the weight of thc
tThe barcmcter
rcading given in English units is usually inches blood exactly balanced the horse's arterial pressura
of mcrcury (in.Hil. 760 mm Hg = 29.92 in. HE
flf According to Hales's observation, the blood
convcntion werc followed, we would quote physiological
prEssucs in torr, but it is common practice in medicine to use
pulsed its way up the tube, attaining a height of
thc unit mm Hg. To avoid confusion, we witl follow this prac- approximately 4 ft on the first pulse but requiring
tice, but kccp in mind that it is no longer accepted outside the an additional 40 or 50 pulses to attain a final
medical world. height of just over 8 ft. After the blood in thc
 Physiologicat Pressure and Other Cardiovascular Measurements and Devices 2s7

Ero tE Exirn{neter tube had stabilized to about the final

oqual to trn6.u it rose and fell approximately 2 or 3 in. on
te roer- aur p,ulse because of the diastolic and systolic
cight as ,rrjjures.
r is d€s- :{*.ies's technique is an example of direct mea-
uhe is mr::nent of blood pressure. Routine clinical mea-
mbcr is mr,B:nents of blood pressure in humans, however,
rErcur.v uar;ed the development of suitable indirect tech-
lilnol to uarr: without the painful and potentially haz-
ra:r-s surgical procedures performed by Hales.
lrJay, both indirect and direct methods are
reJ to measure blood pressure in humans. The
nr::s.t popular indirect method, familiar to almost
e oDe rn
llg. Find
:rr.body whose blood pressure has been checked
t* a physician or nurse, involves sphygmomanom-
Fcssule.
rr.. Currently used direct methods usually involve
g:tnronic amplifiers that process a signal from a
r.rtsure transducer that is coupled to the patient's
mEr! or vein through a saline-filled catheter or
rHg ue;/e. Hales s two-century-old method is still
rscd in modern hospitals to measure spinal fluid
rc easily lcssure and CVP. Almost every hospital stocks
hated at la? and spinal-tap kits that contain a water (HzO)
I 0o spe- m,,anometer not dissimilar to Hales's crude appara-
lhe vari- us of the eighteenth century.
riion to The indirect method routinely used by physi-
ad over rans requires a device called a sphygmomanome'
of gauge ier (Figure 9-3), consisting of an inflatable rubber
eadder called the cuff, a rubber squeeze-ball
+it -. ;, t:;;1,: ;.;.U
r.r.mpand-valve assembly, and a manometer. The ' i :'
"i:,.;i
ma&ometer might be a mercury column (as Flgure $3
nents shown), or a dial gauge. Professional-grade sphyg- Mercury column sphygmomanometer. (Photo
rurement :tomanometers are based on an aneroid assembly courtesy of E. Baum Co., lnc.)
r l7?3 by :r structure similar to the Bourdon tube, while
rn oPen- r:,any cheaper varieties offered as part of "blood
ry in the ]ressure kits" to the general public use spring-
elbow and shoulder. The stethoscope is placed
$ly tied ,oaded pressure gauges. The spring-loaded types
over an artery distal (i.e., downstream) to the
rgh that rre usually just as accurate as more costly types
cuff. This placement (Figure 9-4) is preferred
h of the rnitially, but substantial errors develop as the because the brachial arrely comes close to the
spring wears out.
Iressurc, surface near the antecubital space (i.e., inside
I blood The procedure for using this apparatus is as
the elbow) and so is easily accessible.
bight of follows:
rcquiring 2. The cuffis inflated so that the pressure inside
r a final I. The cuff is wrapped around the patient's upper the inflated bladder is increased to a point
d in the ann at I point about midway between the Sreater than the anticipated systolic prcssure.
258 CHAPTER 9

Cuff pressure

ll0
100
90
tr80
cE70
t60
9so
Zqo
&30
20
l0
0

Artery

Flgure 9.f
cuff placement for the auscultatory method of blood pressure measurement.

This pressure compresses the artery against the usually recorded in the ratio of systolic over
underlying bone, causing an occlusionthat diastolic (i.e., 120/80 mm Hg).
shuts off the flow of blood in the vessel.
The first use of sphygmomanometry for thc
3. The operator then slowly releases (i.e., reduces) measurement of blood pressure was reported by
the pressure in the cuff, shown in Figure 9-5a Korotkoff in 1905, but the technique was not vef,i.
(about 3 mm Hg/s is usually deemed best) and fied for correlation between indirect and dircc
watches the pressure gauge or mercury column. measurements in animals until 1912. It was not un-
When the systolic pressure first exceeds the til 1931 that a similar correlation was establishcd
cuff pressure, the operator begins to hear some for humans-that is, that variations of less than l0
crashing, snapplng sounds in the stethoscope mm Hg existed between direct and indirect m#
that are caused by the first jets of blood pushing ods. More recently it has been shown that indirec Flg
through the occlusion. These sounds, called diastolic pressures are less in error ifthe reading ir Dir
Korotkoff sounds (Figure 9-5D), continue as taken at the point where the Korotkoff sounds dir (4
the cuff pressure diminishes, becoming less appear. Yet most clinicians prefer to use the pdil
loud as the blood flow through the occlusion where the sounds become muffled because tir
becomes smoother. Korotkoff sounds disappear point can be recognized more consistently. Th dk:
or become muffled when the cuff pressure American Heart Association recommended ir tis
drops below the patient's diastolic pressure. 1967 that muffling be tised as the criterion for & cd
To read the blood pressure, the operator notes astolic pressure but that borfi pressures (i.e., muf- eil
both the gauge pressure at the onsel of fling and the cessation of Korotkoff sounds) be ir efi
Korotkoff sounds (systolic) and when the dicated if a significant difference between tlreo be
sounds become muffled (or disappear) exists. This measurement is recorded as a doubb
altogether (diastolic). These pressures are diastolic pressure (i.e.,120/80177 mm Hg). thc
 Physiological Pressure and Other Cardiovascular Measurements and Devices 259

b0

a
o
o.

(a)

frc over

r60
llry for the Cuff pressure
;rcported by 120 E

rx not veri- 80F

t and dircct 40
lwas not un-
I established
f bss than l0 (b)
Lfirect meth-
r tat indirect Flgure S5
Diagram of the auscultalory method ol blood pressure measurement. (a) Cuff placoment.
trcading is (b) Korotkofi sounds.
f,sounds dis-
l:re the point
I tecause this The use of Korotkoff sounds as the indirect in- rately the operator is able to read a changinS pres-
dicator of blood pressure is also called ausculta- sure gauge when the Korotkoff sound features are
rirrently. The
tion (i.e., use of hearing) and is by far the most heard. In hypotensive (i.e., low blood pressure) pa-
hnended in
il:rion for di- coflrmon indirect method used. It is accurate tients, the event chosen to indicate the diastolic
res (i.e., muf- enough for ordinary clinical use and is simple pressure may be either obscured or nonexistent.
mnds) be in- enough so that even nonprofessional personnel can Several modern instruments are available for
tdween them be rapidly trained to "take blood pressures." the indirect measurement of blood pressure in hy-
d rs a double- Limitations on the auscultatory method include potensive patients by replacement of the stetho-
nHg)' the hearing acuity of the operator and how accu- scope with an electronic transducer. Some devices
 CHAPTER 9

from at least two problems. First, the measurement

that use ultrasound are discussed in section 17-10'
is intermittent because it takes time to accomplish'
Other devices that use infrasound (i'e', frequencies t
lower than 50 Hz) are merely low-frequency mi-
A medical person who constantly takes blood I
E
filter pressure readings has little time for anything else' e
crophones. The instrument will amplify and
use it to turn on becond. the Korotkoff sounds are normally in the o
the microphone output signal and is
a
systolic and diastolic range (less than 200 Hz) where human hearing
a beeper Lr nmp when the e
also noir"ry acute. If long-term monitoring in inten- e
features are recognized' These instruments are
sive care is done, or if the ambient noise level
is a
rooms' ICUs, and CCUs where I
used in emergency
high, then either oscillometric or ukrasonic blood
high ambieni noise levels often obscure the Ko-
pressure measurement may be used'
rotkoff sounds on nonhypotensive patients'
There are two other major indirect methods of
blood pressure measurement: palpation and flush'
Both use the cuff but differ in the respective meth- 9-7-1 Oscillometric blood pressure
ods used to detect the pressurc points' measurement
The palpation method uses the sense of to
'orcft The oscillometric method of blood pressure mea-
detect the patient's pulse in the radial artery
surement is similar to ordinary sphygmomanome-
(wris0. The cuff is inflated until the radial pulse (i'e"
try, except that we measure small fluctuations 9{
disappears. The operator then slowly releases the than direct
Flgure
oiciltations) in the cuff Pressure rather lllustration of osd
pt"*ir* in the cuff until a pulse becomes palpable
pressure (Figure 9-6).
in the radial artery' The pressure at which this oc-
When blood breaks through the occlusion cre- riodicallY infl=
curs is the systolic blood pressure'
ated by the inflated cuff, which occurs when the pressure sensc i
Palpation can detect only the systolic pressure
cuff pressure drops below the systolic blood pres- in pressurc r{
becauie no known palpable change occurs at the
sure, the walls of the artery begin to vibrate
diastolic pressure. Also, palpable changes tend to heads.
pres- stightly, The vibrations are related to the fact that
disappear below 75 or 80 mm Hg of systolic
hy- ttre UtooO flow at this point is turbulent, rather than
,u.", * the technique is often not useful on the
9-7-2 Uttrc
potensive Patient.
laminar, although the physiological basis is not
well understood. measl
The flush technique requires two cuffs and rwo
The fluctuating walls of the blood vessel
wc
operators, The cuffs are placed on the arm and Ultrasonic
slightly alter the blood pressure, giving rise-to os- I
are inflated. The blood in the section between the sound wavcs,
ciliations in the cuff pressure (Figure 9-6)' The on-
iwo cuffs is massaged out, leaving the lower arm human treari4
set of the Pressure oscillations correlates well with tilill
pale and blanched. The pressure in the upper acoustical
the systolic pressure' while the amplitude peak of
iuff is then released slowly' The pressure at the oscillations corresponds to the MAP, which is
Doppler shif*
which asudden red flush is noted in the quency (An tl
the time average of blood pressure' The diastolic
blanched skin is recorded as the mean arteial If piezoelectrb
pressure event on the oscillation curve is some- rd
pressure (MAP). the arterY,
what less well-defined than the systolic event but Doppler detecri
corresponds to the point where the rate of ampli- The PrinciPl
tude decrease suddenly changes slope'
9-7 Oscillometric and ultrasonic Oscillometric blood pressure monitors are used
uansmit crY$l
noninvasive pressune tissue. When I
extensively when monitoring is needed, but it is (see section 91
measurements not desirable for invasive procedures where direct
back ("backsc
pressure measttrements are needed (section 9-8)'
The aforementioned auscultatory nleasurement which is locar
method is the most widely used procedure for A typical oscillometric blood pressure monitor is is the DoPPb
microprocessor-controlled and is designed to pe-
measuring blood pressures. It suffers, however'
Biomedical Signal Processing

2.4 Cardiac output, Heart Sounds

Edited By : Nishikant Surwade

 Next Page

34 /NTRODUCT/ON TO BlOMEDlCAL SIGNALS

with contractions; they are related to the spatial and temporal organization of gastric
contractions.
External (cutaneous) electrodes can record the signal known as the electrogas-
trogram (EGG). Chen et al. [38] used the following procedures to record cutaneous
EGG signals. With the subject in the supine position and remaining motionless,
the stomach was localized by using a 5 M H a ultrasound transducer array, and the
orientation of the distal stomach was marked on the abdominal surface. Three active
electrodes were placed on the abdomen along the antral axis of the stomach with
an inter-electrode spacing of 3.5 cm. A common reference electrode was placed
6 cm away in the upper right quadrant. Three bipolar signals were obtained from the
three active electrodes in relation to the common reference electrode. The signals
were amplified and filtered to the bandwidth of 0.02 - 0.3 Hz with 6 dB/octave
transition bands, and sampled at 2 Ha.
The surface EGG is believed to reflect the overall electrical activity of the stomach,
including the electrical control activity and the electrical response activity. Chen et
al. [38] indicated that gastric dysrhythmia or arrhythmia may be detected via analysis
of the EGG. Other researchers suggest that the diagnostic potential of the signal has
not yet been established [35,36]. Accurate and reliable measurement of the electrical
activity of the stomach requires implantation of electrodes within the stomach [39],
which limits its practical applicability.

1.2.8 The phonocardlogram (PCG)

The heart sound signal is perhaps the most traditional biomedical signal, as indi-
cated by the fact that the stethoscope is the primary instrument carried and used by
physicians. The PCG is a vibration or sound signal related to the contractile activity
of the cardiohemic system (the heart and blood together) [23, 40, 41, 42, 43, 441,
and represents a recording of the heart sound signal. Recording of the PCG signal
requires a transducer to convert the vibration or sound signal into an electronic signal:
microphones, pressure transducers, or accelerometers may be placed on the chest sur-
face for this purpose. The normal heart sounds provide an indication of the general
state of the heart in terms of rhythm and contractility. Cardiovascular diseases and
defects cause changes or additional sounds and murmurs that could be useful in their
diagnosis.
The genesis of heart sounds: It is now commonly accepted that the externally
recorded heart sounds are not caused by valve leaflet movements per se, as earlier
believed, but by vibrations of the whole cardiovascular system triggered by pressure
gradients [23). The cardiohemic system may be compared to a fluid-filled balloon,
which, when stimulated at any location, vibrates as a whole. Externally, however,
heart sound components are best heard at certain locations on the chest individually,
and this localization has led to the concept of secondary sources on the chest related
to the well-known auscultatory areas: the mitral, aortic, pulmonary, and tricuspid
areas [23]. The standard auscultatory areas are indicated in Figure 1.17. The mitral
area is near the apex of the heart. The aortic area is to the right of the sternum, in the
second right-intercostal space. The tricuspid area is in the fourth intercostal space
Previous Page

EXAMPLES OF BIOMEDICAL SIGNALS 35

near the right sternal border. The pulmonary area lies at the left parasternal line in
the second or third left-intercostal space [23].
A normal cardiac cycle contains two major sounds - the first heart sound (Sl)
and the second heart sound (S2). Figure 1.24 shows a normal PCG signal, along with
the ECG and carotid pulse tracings. S1 occurs at the onset of ventricular contraction,
and corresponds in timing to the QRS complex in the ECG signal.

-2
I

0.1
I

0.2
I

0.3
Y 'I

0.4
I

0.5
I

0.6
I

0.7
I

0.8
I

0.9
I

E
u0

0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

:
I
2 0
0
-1 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

Time in seconds

Figure 1.24 Three-channel simultaneous record of the PCG,ECG,and carotid pulse signals
of a normal male adult.

The initial vibrations in S1 occur when the first myocardial contractions in the
ventricles move blood toward the atria, sealing the atrio-ventricular (AV - mitral
and tricuspid) valves (see Figure 1.25). The second component of S 1 begins with
abrupt tension of the closed AV valves, decelerating the blood. Next, the semilunar
(aortic and pulmonary) valves open and the blood is ejected out of the ventricles.
The third component of S1 may be caused by oscillation of blood between the root
of the aorta and the ventricular walls. This is followed by the fourth component of
S 1, which may be due to vibrations caused by turbulence in the ejected blood flowing
rapidly through the ascending aorta and the pulmonary artery.
Following the systolic pause in the PCG of a normal cardiac cycle, the second
sound S2 is caused by the closure of the semilunar valves. While the primary
vibrations occur in the arteries due to deceleration of blood, the ventricles and atria
also vibrate, due to transmission of vibrations through the blood, valves, and the
valve rings. S2 has two components, one due to closure of the aortic valve (A2)
36 INTRODUCTION TO BIOMEDICAL SIGNALS

A. COMPONENTS OF FIRST HEART SOUND

Figure 1.25 Schematic representation of the genesis of heart sounds. Only the left portion
of the heart is illustrated as it is the major source of the heart sounds. The corresponding
events in the right portion also contribute to the sounds. The atria do not contribute much to
the heart sounds. Reproduced with permission from R.F. Rushmer, Cardiovascular Dynamics,
4th edition, @W.B.Saunders, Philadelphia, PA, 1976.
 EXAMPLES OF BIOMEDICAL SIGNALS 37

and another due to closure of the pulmonary valve (P2). The aortic valve normally
closes before the pulmonary valve, and hence A2 precedes P2 by a few milliseconds.
Pathologic conditions could cause this gap to widen, or may also reverse the order
of occurrence of A2 and P2. The A2 - P2 gap is also widened in normal subjects
during inspiration. (Note: The PCG signal in Figure 1.24 does not show the A2 and
P2 components separately.)
In some cases a third heart sound (S3) may be heard, corresponding to sudden
termination of the ventricular rapid-filling phase. Because the ventricles are filled
with blood and their walls are relaxed during this part of diastole, the vibrations of
S3 are of very low frequency. In late diastole, a fourth heart sound (S4) may be
heard sometimes, caused by atrial contractions displacing blood into the distended
ventricles. In addition to these sounds, valvular clicks and snaps are occasionally
heard.
Heart murmurs: The intervals between S 1 and S2, and S2 and S 1 of the next
cycle (corresponding to ventricular systole and diastole, respectively) are normally
silent. Murmurs, which are caused by certain cardiovascular defects and diseases,
may occur in these intervals. Murmurs are high-frequency, noise-like sounds that
arise when the velocity of blood becomes high as it flows through an irregularity
(such as a constriction or a baffle). Typical conditions in the cardiovascular system
that cause turbulence in blood flow are valvular stenosis and insufficiency. A valve is
said to be stenosed when, due to the deposition of calcium or other reasons, the valve
leaflets are stiffened and do not open completely, and thereby cause an obstruction or
baffle in the path of the blood being ejected. A valve is said to be insufficient when it
cannot close effectively and causes reverse leakage or regurgitation of blood through
a narrow opening.
Systolic murmurs (SM) are caused by conditions such as ventricular septal defect
(VSD - essentially a hole in the wall between the left ventricle and the right ven-
tricle), aortic stenosis (AS), pulmonary stenosis (PS), mitral insufficiency (MI), and
tricuspid insufficiency (TI). Semilunar valvular stenosis (aortic stenosis, pulmonary
stenosis) causes an obstruction in the path of blood being ejected during systole. AV
valvular insufficiency (mitral insufficiency, tricuspid insufficiency)causes regurgita-
tion of blood to the atria during ventricular contraction.
Diastolic murmurs (DM) are caused by conditions such as aortic or pulmonary
insufficiency (AI, PI), and mitral or tricuspid stenosis (MS, PS). Other conditions
causing murmurs are atrial septal defect (ASD), patent ductus arteriosus (PDA), as
well as certain physiological or functional conditions that cause increased cardiac
output or blood velocity.
Features of heart sounds and murmurs, such as intensity, frequency content, and
timing, are affected by many physical and physiological factors such as the recording
site on the thorax, intervening thoracic structures, left ventricular contractility, posi-
tion of the cardiac valves at the onset of systole, the degree of the defect present, the
heart rate, and blood velocity. For example, S 1 is loud and delayed in mitral stenosis;
right bundle-branch block causes wide splitting of S2; left bundle-branch block re-
sults in reversed splitting of S2; acute myocardial infarction causes a pathologic S3;
and severe mitral regurgitation (MR) leads to an increased S4 [40, 41, 42, 43, 441.
38 INTRODUCTION TO BIOMEDICAL SIGNALS

Although murmurs are noise-like events, their features aid in distinguishing between
different causes. For example, aortic stenosis causes a diamond-shaped midsystolic
murmur, whereas mitral stenosis causes a decrescendo - crescendo type diastolic -
presystolic murmur. Figure 1.26 illustrates the PCG, ECG, and carotid pulse sig-
nals of a patient with aortic stenosis; the PCG displays the typical diamond-shaped
murmur in systole.
Recording PCG signals: PCG signals are normally recorded using piezoelectric
contact sensors that are sensitive to displacement or acceleration at the skin surface.
The PCG signals illustrated in this section were obtained using a Hewlett Packard
-
HP21050A transducer, which has a nominal bandwidth of 0.05 1,000 Hz.The
carotid pulse signals shown in this section were recorded using the HP2 1281A pulse
transducer, which has a nominal bandwidth of 0- 100 Hz.PCG recording is normally
performed in a quiet room,with the patient in the supine position with the head resting
on a pillow. The PCG transducer is placed firmly on the desired position on the chest
using a suction ring and/or a rubber strap.
Use of the ECG and carotid pulse signals in the analysis of PCG signals will be
described in Sections 2.2.1,2.2.2, and 2.3. Segmentation of the PCG based on events
detected in the ECG and carotid pulse signals will be discussed in Section 4.10. A
particular type of synchronized averaging to detect A2 in S2 will be the topic of
Section 4. I 1. Spectral analysis of the PCG and its applications will be presented in
Sections 6.2.1, 6.4.5, 6.6, and 7.10. Parametric modeling and detection of S1 and
S2 will be described in Sections 7.5.2 and 7.9. Modeling of sound generation in
stenosed coronary arteries will be discussed in Section 7.7.1. Adaptive segmentation
of PCG signals with no other reference signal will be explored in Section 8.8.

1.2.9 The carotid pulse (CP)

The carotid pulse is a pressure signal recorded over the carotid artery as it passes
near the surface of the body at the neck. It provides a pulse signal indicating the
variations in arterial blood pressure and volume with each heart beat. Because of the
proximity of the recording site to the heart, the carotid pulse signal closely resembles
the morphology of the pressure signal at the root of the aorta; however, it cannot be
used to measure absolute pressure [41]. The carotid pulse is a useful adjunct to the
PCG and can assist in the identification of S2 and its components.
The carotid pulse rises abruptly with the ejection of blood from the left ventricle
to the aorta, reaching a peak called the percussion wave (P, see Figure 1.24). This
is followed by a plateau or a secondary wave known as the tidal wave (T), caused
by a reflected pulse returning from the upper body. Next, closure of the aortic valve
causes a notch known as the dicrotic notch (D). The dicrotic notch may be followed
by the dicrotic wave (DW, see Figure 1.24) due to a reflected pulse from the lower
body [41]. The carotid pulse trace is affected by valvular defects such as mitral
insufficiency and aortic stenosis [41]; however, it is not commonly used in clinical
diagnosis.
The carotid pulse signals shown in this section were recorded using the HP21281A
pulse transducer, which has a nominal bandwidth of 0 - 100 Hz.The carotid pulse
Biomedical Signal Processing

2.5 Nervous System: Nervous System, Electrical activity of

nerve cell, Synapse, Reflex action and Receptors.

Edited By : Nishikant Surwade

 Handbook of Biomedical lnstrumentation

pharynx, larynx, trachea, bronchi and bronchioles. The passage way bifurcates
to carry air into
each of the lungs wherein it again subdivides several times to irry
air into and out of each of the
many tiny air spaces (alveoli) within the lungs. In the tiny air spaces of the lungs
is a membrane
interface with the hydraulic system of the body through which certain
gases can defuse. oxygen
is taken into the blood from the incoming air and carbon dioxide
is transferred from the blood to
the air under the control of the pneumatic pump. Thus, the blood
circulation forms the link in the
supply of oxygen to the tissues and in the removal of gaseous waste products of
metabolism. The
movement of gases between blood and the alveolar air is basically due to constant
molecular
movement or diffusion from points of higher pressure to points of lower pressure.

. An automatic respiratory control centre in the brain maintains heart pump operation at a speed
that is adequate to supply oxygen and take away carbon dioxide as requlredty
the system. h each
minute, undernormal conditions, about250ml of oxygen are taken upand 256 d
of CO, are given
out by the body and these are the amounts of the two gases, which enter and leave
the blood in the
lungs. Similar exchanges occur in reverse in the tisiues where oxygen is given
up and CO, is
removed. The exact arrrount of CO, expired depends upon the metatolism,
the acid-base balance
and-the pattem of respiration' The exchange of gases takes place in the
alveoli and can be achieved
by the normal 15-20 breaths/min, each one involving abolt soo ml of air.

. The respiratory system variables which are important for assessing the proper functioning of
thesystem are respiratory rate,respiratory air flow, respiratory volu^L u.rd
.or,.entration of CO,
in the expired air. The system also requires measurements to be made of certain
volumes and
capacities such as the tidal volume, vital capacity, residual volume, inspiratory
reserve volume
and expiratory reserve volume. The details of these are given in Chaptei 13.

1.2.3 The Nervous System

The nervous system is the control and communication network for
the body which coordinates the
functions of the variou: organs. Rapid communication between the varitus
parts, the effective,
integrated activity of different organs and tissues and coordinated contraction
of muscle are
almost entirely dependent upon the nervous system. It is thus, the most highly
developed and
complex system in the body. The centre of all these activities is the brain (-central
information
processor) with memory, comPutational power, decision making capability
and a host of input
output channels.

(Fig. 1.4) made up of the encephalon (brain) and the spinal thu peripheral nervous system
comprises all the nerves and groups of neurons outside the "oid.
brain and the spinal cord.
The brain consists of three parts, namely, the cerebrum, cerebellum and, thebrain
stem.
Cerebrum: The cerebrum consists of two well demarcated hemispheres, right and left and each
hemisphere is sub-divided into two lobes:/rontal lobe and temporaliobein the"lefthemisphere
and
parietal and occipital lobes inthe right hemisphere (Fig. 1.5). The outer layer
of the brain is called the
cerebral cortex. All sensory inputs from various parts of the body eventually
reach the cortex, I
where certain regions relate specifically to certain modalities of sensory inftrmation. me[
Variou-s
areas are responsible for hearing, sight, touch and control of the
voluntai muscles of the bodr,. silur
 F undamentals of Medical lnstrumentation

arn'air into
*each of the
lmembrane
use. Oxygen
ttrcblood to tr
-e
lElinkinthe (,
tbolism. The o
I molecular
UJ

rrat a speed
fui.L:reach
Qaregiven Posterior
rHoodinthe nerve
t and COz is roots
hasebalance Cervical
Spinal
rbe achieved spinal
nerve
cord

rrtioning of
ation of CO,
olumes and
:fffe Thoracic
"rOlUme spinal
cord
E
o
o
E
'a
ndinates the
a
he effective,
imuscle are
nloped and Lumbar
information spinal
cord
retof input

us system is Sacral
spinal
,u.rs system cord
L
l
dtand each
bphere and > Fig. 1.4 Centtalneruous system,humanbrain and spinal coril
iscalled the
ttre cortex, The cerebral cortex is also the centre of intellectual functions. The frontal lobes are essential for
cu Various intelligence, constructive imagination and thought. Here, large quantities of information can be
f thebody. stored temporarily and correlated, thus making a basis for higher mental functions.
 L0 Handbook of Biomedical lnstrumentation

Cerebral cortex
Parietal lobe

Thalamus

Corpus callosum
Hypothalamus

Occipital lobe
Frontal lobe

Pituitary

Temporal lobe
Bnri:
Cerebellum Jer'&:
iectiu
..
a500
,;erati[
Medulla oblongata
r

=ct-il
> frig. 1 .S Cut-azuay section of the human byain :g"*q
rrhich
Each point in the motor centre in the cerebral cortex (Fig. 1.6) corresponds to a the Io
certain bodv
movement. In the anterior part of the parietal lobe lies the terminal station for the nerve pathways temfI
conducting sensation from the opposite half of the body. The sensory centre contains tt.t.rst-
counterparts
of the various areas of the body in different locations of the cortex. 'ih" ,"nro.y inputs
come from Sfirr,
the legs, the torso, arms, hands, fingers, face and throat etc. The amount of surface
allotted to each the Ia
part of the body is in proportion to the number of sensory nerves it contains rather than its
physical size. The visual pathways terminate in the posterior part of the occipital lobe. The rest
actua] tftIei
of andp
the occipital lobes store visual memories, by mear,sbf rrhich we interpret what we
see. Thecr
On the upper side of the temporal lobe, the acoustic pathways terminate making it as a hearing
hrd]-,
centre. This is located just above the ears. Neurons responding to different frequJncies
of sound contr
input are spread across the region, with the higher frequencies located towards the front and iorv
a resu
frequencies to the rear of the ear. The temporal lobes are also of importance for the storage
process h-isLle
inthelong-terrnmemory.
Th
Cerebellum: The cerebellum acts as a physiological microcomputer which intercepts various neurc
sensory and motor nerves to smooth out the muscle motions which could be otherwise jerky. It nainl
also
consists of two hemispheres which regulate the coordination of muscular movementi triurst
elicited br-
the cerebrum. The cerebellum also enables a person to maintain his balance. sirnu
tr: all
 11
F undamentals of Medical lnstrumentation

Motor

ciital lobe

> Fig. 1.6 Sites of some actiaity centres inthe cercbral cortex

to .:11tu of the brain iust below the

Brain stem:The brain stem connects the spinal cord fhe
are (i) Medulla oblongatawhich is the lowest
*rrn cerebral cortex. The essential parts of the brain stern
section of the brain stem and contains centres
for regulating thework performed by the heart' the
centre which controls the
centres, which control blood distributi6n anrl-respiratory
'asomotor the medulla and protruding somewhat in
ventilation of tfre fungt 111) theponslocated just above
r6aongata part of the brain stein (iv) the
front of the brain stem. (iii) midbrain wnich lies in the upper
diencephalonis located aboo'" and slightly forward of
tn" *id Urain' It has one part' thethalamus '
sensory centre of the cerebrum' In
which acts as a relay station for sensolry path'o'ays to the cortical
whic]n has several vital centres for
rtain body the lower part of the diencePhalon is the hypothalamus
They include the centres for appetite'
lpathways temperature regulation, metaiolism and fluid"regulation'
for subiective feelings and emotions'
imterparts thirst, sleep and sexual drive. The hypothalamus is important
the medulla oblongata in thebrain to
mme from spinal coril:Thespinal cord is a downward continuationof
of nerve tissue about the thickness of the
hd to each the level of first lumbar vertebra. It consists of a cylinder
consists of white matter on the surface
nits actual little finger and has a length of about 38 to 45 "*r. Thu cord
The rest of and grav matter inside. The white matter contain
fibres running between the cord and brain only'
foithe link between the brain and the
t
The cord containing motor and sensory fibres is responsible
spinal cord are located the neurons that
sahearing body and reflex action. In the H-shaped gray matter of the
bladder- emptying reflex. The reflex action is
s of sound control manv reflexes such as the knee reflex and the
ntand low a result of the stimulation of the motor cells
by stimuli brought in by sensory nerves from the
f8e Process tissues.
cells about half of which' called
The central nervous system consists of billions of specialized
r,r'hile the other half (supporting cells)'
lts various neurons, are functionaliy active as signal transmitters
of the neurons is the ability to
:rlcl'. It also maintain and nourish rhu nurro.r. The fundarnental property
to changes in their environment' i'e'
e{icited by transmit electrical signals, called nerve impulses, in response
muscles oi the body and is responsible
stimuli. The centrat iervous system controls the voluntary
for all movernents and sensations'
 t2 Handbook of Biomedical lnstrumentation

The basic functional unit of the nervous system is the neuron. A typical neuron consists of a
nucleated cell body and has several processes or branches (Fig. 1.7). The size and distribution of
these branches vary greatly at different sites and in cells with different functions, but the two main
kinds are: the qxone and the dendrite. The dendrites normally conduct impulses toward the cell il
F
body and the axons conduct away from it.

Cell body
I
;

&
F
lmpulse transmission

> Fig. '!

.7 Structure of the neuron and the phenomenon of impulse transmission
I
The neurons form an extremely complex network, which connects all parts of the body. While
T
the size of the central body of the nerve cell is the same as that of other cells of the body, the overall
size of the neuron structure varies from a millimetre or so in the spinal cord to over a metre in
length. For example, the axones of the foot muscle originate in the lower part of the spinal cord,
n
where the associated nerve cells are located. "c#
The nervous system is the body's principal regulatory system and pathological processes in it
often lead to serious functional disturbances. The symptoms vary greatly depending upon the
part of the nervous system affected by the pathological changes. The measurements on the nervous
system include recording of electroencephalogram (EEG) and muscle's electrical action potentials,
I
electromyogram (EMG), measurement of conduction velocity in motor nerves, and recording of the x
ft
peripheral nerves' action potential, electroneurogram (ENG). *
ji,

1.2.4 Other Systems

There are some other important functional systems in the body, such as digestive system, excretory
BioeId
system, reproductive system and the biochemical system which perform vital functions required
andmtg
to carry out the various body functions. The coverage of all these and other systems is outside the
mar-ttee
scope ofthisbook. il cells cut
ECG (€{e
ixirii> 1.3 SOURCES OF BIOMEDTCAL STGNALS Bioacol
menaPn
Biomedical signals are those signals (phenomenon that conveys information) which are used
t-lc'rr ot b
primarily for extracting information on a biological system under investigation. The process of
extracting information could be as simple as feeling the pulse of a person on the wrist or as
aintals
complex as analyzing the structure of internal soft tissues by an ultrasound scanner. Biomedical ,l
Biorrr, d
signals originate from a variety of sources (Fig. 1.8) such as:
{ s!'she[L'
Biomedical Signal Processing

2.6 Structure and functions of Neurons

Edited By : Nishikant Surwade

PA 15216,
L Describes
rtathing
ling as Part
rurd
CHnpTER 12
The Human Nervous System

12-1 Objectives
1. Be able to introduce the biological principles and spinal cord), PNS (nerve pairs), and ANS
underlying the human central nervous system (sympathetic and parasympathetic systems).
(CNS), the peripheral neryous system (PNS), 3. Be able to identify specific areas of the brain
and the autonomic nervous system (ANS). concerned with bodily sensory and motor
2. Be able to describe the structure and function functions.
of the neuron (single nerve cell), CNS (brain

1 2-2 Self-evaluation questions 5. Name the four lobes of the cerebrum.

These questions test your prior knowledge of the 6. Identify the areas of the brain responsible for
material in this chapter. Look for the answers as the senses ofsight, sound, touch, smell, and
you read the text. After you have finished studying taste.
the chapter, try answering these questions and
7. Identify the areas ofthe brain responsible for
those at the end of the chapter.
thefunction of muscle movement, memory,
1. List the major divisions of the neryous system. intelligence, judgment, imagination, creativity,
and conscious thought.
2. Draw a diagram and define various portions of
a neuron (single nerve cell). 8. How does blood circulate through the brain?

3. Describe nerve impulse conduction through 9. What is the purpose of the three membranes
one neuron and several neurons connected (meninges) covering the brain?
together.
10. Does human behavior control brain function,
4. Describe the basic structure and function of or does brain function control human
the CIVS, PNS, and ANS. behavior?

367
368 CHAPTER 12

ative feedback loops involving nervous (electre lCa

12-3 Organization of the nen ous chemical) and humoral (biochemical) components. d
system For example, blood carbonate is detected in thc oh
brain. If it is too high (indicating too much carbon
The nervous system is a complex interconnection dioxide in the blood), the brain initiates movement
Lfui
of nervous tissue that is concemed with the inte- of breathing muscles. This, in tum, increases crj
gration and, control of all bodily functions. We breathing rate and rids (ventilates) the body of car-
dr
know that this system allows an individual to de- bon dioxide gas through the lungs.
dt
ircH
,ec, internal and external environmental changes The nervous system is generally considered tlre
(stimuli) and to interpret (analyze) the resulting most complex bodily system. It is divided into sev- r.h
nerve impulses. eral major divisions distinguished by anatom.v dr
Homeostasis (constancy or stability in internal (structure and location) and physiology (function), d
body states) is achieved through a network of neg- including the following:

NERVOUS SYSTEM
Thc Nervos System ir concerncd with thc INTEGPATXSN and @NTROL
of ell bodilv functions.
It hae ipccielizcd in IR,RITABILITY- cha abi/rty 6nccivc tad4TssljP
and arso i.
"ofi'6ffiii3t
f;7f:fii{lhi#;:ffi*
end troi coVFDNTrrtrc cc'ur*s.

Thr NERVOUS SYSTEM

consigts of
a
I
I
I
CENTRAL PAFT -
77lc B,QAlNand
SP/NAI @2D

linkcd by en
artlying
or

LSE NSOFY Ncrvc f ibcr crry hcrorgar

| ,/ fmm Tirsucg end Organr to thc
PERIPIIER.AL PART-Ncrvc fibre:' Brain or Spinal C.ord.

I
TISSUES end ORGANS
MOTOR Nervc fibrcs c.rrv m.as.qr!
to Ti3suc. end Oroanifrom t'hc
of thc body Brain or- Spinal Conj.

Flgure 12-1 Flgure lAt

The nervous system. (McNaught, Ann B. and Robin Callander, lllustruted Physiology, Churchill Nervous tir
Livingstone, New York, 1976. Used by permission.) Churchill Urir
 The Human Nervous System 369
B (electro- l. Central nervous system (CNS), which
is
mPonents. b. Autonomic nervous system (ANS),.wtnch
enclosed within the skull and vertebral
red in thc supplies smooth muscle, cardiac
column-braln and spinal cord. muscle, and
nch carbon glands-in the body viscera. T\e sympathetic
Dovement ! Peip.heral nervous system(pNS),
which . (stimtlatory) sysrem causes
org* .h*g"*
increases consists of nervous tissue outside that help the body resist stress]Th
the skull
rdy of car- and vertebral column_periphery parasympatheric (inhibitory)
(extrernity) system maintains
of the body. Subdivisions of the pNS normal function and conserves
body resources.
Llered the include:
I into sev- a. Somatic system, which supplies Figure l2-l shows an overview of the nervous
sensory motor system.
anatomy and sensory fibers to the skin
and skeletal Humans have the ability to perceive
function), muscles. . their en_
vironment as well as to receive
tt. ne,rrpin

tfu@i./

crll, forkiniccrlt.

Hffi,
CERESR.AT CEEEEEtU'M
conTEX
(dprfutent
(,tlylhatca) (l,bt.ayc/tnated) Autlortoark
cbh)
_..-. AXON... \..
:::.....MYELrN
tpoE ot
NANVIER

-
-. SCHWANN -
onecrtar I '. CELr
ol l,ltfutSE I NUCLEUS
cot{NECTtvz
"---TlssuE sxcerx._

.----tlcrye Endtngs--
S&clct l Smooth-.
,nuaclc
lvlxC mutltpola? ncutrcncc
alrc *t'24&;AP,T
,tmr nnction.
12.2
McNausht & catlander, tttustrated physiotosltUsed
m, ffi;lll"J by permission of
370 CHAPTER 12

involves response to environmental stimuli, while fiber. Figure l2-2 shows a nerve cell
perception relates to the recognition of symbolic skeletal muscle and to smooth muscle.
patterns. These patterns are abskact (not physical) the nerve impulse travels in one dfuc(i
and are composed of linguistic symbols. The abil- from dendrites to nerve endings. The a.rc
ity of the human to think of the physical world in the entire length of the nerve cell, ard
abstract terms accounts for the extraordinary talent sunounded by a myelin sheath (segffi
to manipulate objects, construct houses, and con- lating covering). The neurilemma
trol his or her environment. this sheath and is composed of Sclrxm
Nodes of Ranvier act to speed up the
pulse transmission.
12-4 The neuron (single nerue cell)
The rransrn ission of the nene impukc's
Tlte neuron is the fundamental unit of the nervous a result of biochemicals that travel
system. It is a single cell composed of a cell body synapse (space between nerve cells). The
(soma), several short input projections (dendrites), membrane permeability is the chief reason
and a long propagation channel (axon). The axon pulse transfer across the synaptic junctim
together with its sheath (covering) forms the nerve l2-3 shows the synaptic ultrastructure.

Flgure 12-3
Synaptic ultrastructure.
 The Human Nemous SYstem 3'71

alrangements:
nect to each other in the following
E and PostsynaPtic membranes and one to one, one to many'many to one' or. many to

*. *" excitaiory postsynaptic q"t*:1"]

"'H" figrt"
i"*V. 12-4 shows these possibilities'
Sili; oflconduction' and
l,jgl,rt r"r"rt uion, una dendrites (nerve fibers)
bundle
p".ttyraptic potential (IPSP) results together to form a nerve'
The sensory nerves car-
"i"oy or inhibited, conduction'
klrrsed, as ffirent nerves' and
wave JJJ ,o ,t brain are known
Th cooduction pulse results in a " awav from the brain are called.e/-
9fdeno-
similar to that pre- ;;;;;ed on and off in such a
. (a"tion potential) ferent nerves. Nerves switch
;;;; muscle in chaPter 2' ParticularlY ;;;";;t;;.u'*" ub'upt changes in cell voltages'
is in one di-
l'-{^ii'q. Nerve conduction is similar'to
in-.f"",, this nerve impulse switching nerve cells
inrr-1.ont,*t speed) from dendrites
logic' Several
digital circult
rIT ,ron to nerve endings' Neurons can
con-
"*.it*i.

p- ARRANGEMENT Of NEURQNES hcrc;

ilG indicalcd
can b' link'd rre
th. w'yt inwhich n3urcil!'
p
yvffihz/wt-:;m
Sotaa of

rI "fr#

wwilz?'r-wz*th-ffi
fr\,qg::t- -"'-.H#
Wffim,ffi
g*{c*flf*-,zr,Ma
hner-tblecll
sy'itl caa.

Flgure 12-4 tllustruted Physiology'

(From lvtcNaught & callander,
r,rranoements ol neurons lneurones).
*"a*'iv'pJiiii;sionolCnurcnillLivingstone')
 rmr' E
- n0-f
ffilfrrllr
:oourfud
fi{frs
rc,{,r
flU@EE:
#mq o
&lmn
Flgure 12-5 &;m
Components of reflex arc. (From Human Anatomy and Physiologlq 2nd edition, by James E. *-: -D
Crouch, Ph.D. and J. Robert Mc0lintic, Ph.D. John Wiley & Sons, New York, 1976. Used by
permission.) . r- rxt
: q"od
CEREBRUM ffInuu

Thc largcst part of thc human brain is the CEREBRUM - madc up ol I r-:m
2 CEnEBPAL-HEMISPHERES Each of thase is dividcd into LOBEs. rrgrlh
lNlTlATlN6 CENTRES for RECEIVING CENTRES for r[ .{ m&
OUTGO,NG mcstagcs INCOMING information
I qr4!i
mollllt!
rql6{
t. r*xrs
@iruf,m

r2-5 S
c{
lme r.am
ls;irc ,3:
::!9il4.!.&1r|["

rrrxli-lr Fl
jmrm-flu
Laroe uncharted arcas of the Ccrebral Hemispheres IrrrHm!l,(
are'probably conccrncd with MENTAL PROCESSES
such as /nte//tbcncc, Memory, Judgcmcnq
/mcgthatrbn,- Creativc and Consc,ous ThoughA
The surface of thc brein shows many folds or
CONVOLUTIONS. This has Lhe eflect ol -u ::@
incrcasino thc.mounc of GREY MATTER Prcscnt. mcl :ori.
Thc GREY'MATTER, forms thc outcr layer or r=i lmEE
CORTEX. lt contains thecell bodios ot thc lma !ri:t[
NEURONES arranqcd in many intcrconnccting trr4ur:3: fi
layero to form a 3'dimcnsional network.
uef -i]:ri l
,About 90% of all Ncrve Cclls are
in thc Cerebral Gortex. iu:ur;r 1a
r 0a :[]iflir
Flgure 12{ lmro la
The cerebrum. (From McNaught & Callander, lllustrated Physiology. Used by permission ol 7'm-; fr
Churchill Livingstone.) Fnlir:conu
372
 The Human Nervous SYstem 313

imuri :€ required to conduct before a triggering tion, and the cerebrum--voluntary movement'
is reached. The AND and OR functions
tM*,nr:,-nl. sensation, and intelligence.
mrr:;r--neC by nerve cells act to control bodily
,lcilt$rJ1a-:;1u on and refl exes. 12-5-1 Brain stem
lrcx action in the human involves many reflex
lmil- {
rervous reflex is an involuntary action re- Tlte brain sfern consists of the medulla (oblon-
mnr:n:.c ;aused by stimulation of an afferent nerve
gata), pons, midbrain, and diencephalon'
ullll::x or receptor. The knee jerk in response to The medulla automatically controls heart rate
iltur ;: .:ri a hammer is one example of a reflex arc, and breathing. (Actually, most essential life sys-
tems are controlled here.) Reflex functions such
as
fum ::,mponents of which are shown in Figure
; : ltrc components of the arc are: coughing, sneezing, and vomiting are associated
witli the medulla. Indeed, one modern definition of
- '€ceptor, which detects change. clinical death is the absence of lower brain EEG
\ '.:" efferent neuron, which conducts the nerve
activity.
i:;ulse from the sensory area to the CNS' The pons is about 2.5 cm long and forms a no-
ticeable bulge on the anterior surface of the brain
*. :enter or synapse, which connects neurons
stem. It Ttrnction.t as a relay station for motor res-
" ,:"eetler. piratory and auditory fibers from the cerebrum and
{ \ :rain processing area. cerebellum. Other impulses from eye movement'
head muscles, and taste sensors also pass through
'. ',:- efferent neuron, which conducts nerve here.
::ulses from the CNS to an organ for The midbrain is a wedge-shaped portion of the
1;f,roPriate response. stem. Midbrain tissues function as a motor relay
:. \: effector or organ, which resPonds to station for fibers passing from the cerebrum to the
:-a:ntain homeostasis. cord and cerebellum. Integration of visual and au-
ditory reflexes, including those concemed with
avoiding objects, also occur here.
'2-5 Structure and function of the T\e diencephalon forms the superior (top) part
central nervous system* of the brain stem. As part of the original forebrain'
*:r brain is defined as "a large sott mass of nerve it develops into the thalamus and hypothalamus'
: .,*e contained within the cranium' lhe en' T\e thalamus receives fibers from the hearing
strucrures of the inner ear and visual system' It
r,'.t!on."t Three major structures compose the
also provides Pathways for somatic sensory sys-
:';.,: (Figures l2-6 through l2-9)'. the brain
All this sensory information eventually
tems-
ini'.F,-automatic vital system control, the cerebel'
reaches the cerebrum, where it is processed'
a--involuntary muscle control and coordina-
to the properties of
The hypothalaLnus responcls
blood passing through nerv'e connections' The en-
"-:c central nervous system is composed of the brain and docrine systen is controlled through nerve re-
i;::a cord, Many excellent drawings and photographs have- sponses, affecting emotional behavior Patterns'
rr by anatomists. Yokochihas excellent pictures of
o,resenred
Other functions controlled via chemical interaction
u::rurl brain tisiue. Frank H. Netter, Ciba Pharmaceutical
picture Presenu- with the pituitary gland we temperature regula-
'*.crcrs, lnc., has a superb l3-minute motion
-;c irom the Department of Anatomy, U'C'L'A' Medical don, water balance, food intake, gastric secretion'
.uLr:l lTeaching Films, Houston, Texas, Clemintioe and Hard- sexual behavior, and sleeping pattems.
n,:r enlitled Guides to Dissection, The Cranial Caviry- As a general arousal mechanism, the reticular
),rtal
-:lvr's
of the Brain.
F'A' Davis Co' activation system (MS) functions with the thala-
Cyclopedic Medical Dictionary' of
;! lidelphia, 1973). mus to Prepare the cerebral cortex (higher parts
l"t4 CHAPTER 12

Thir viow thotc curfrcc GPFi MATTERcontlining Nervr Ccllr end

i"n.r'wHifgMAfTEE madc up of Ncnt Fibrrs'
-Oi-iiJf 'trliii-"prrn"." thcrr ere rdditiond
Dco in thc .ubstrncc "i-til
merrc'c of GREY MATTER:-

7r. MSAL GANGLIA ,nd IHALAMIII

ctAUsTQU ,t----1 ,E Vantrich
t'lnfcnql{aaol
tWQ(lt STPATUA'I I
ltntifwn Nchus \ latrral \&ntriclc
Gbahllda-- l. / 'twana
tutm--t t. I
't

'.,-At
i ';;;rtii;&
vtt)tdla
dsdotc. \. \

77h Brrrl G:ng!j1

erc cgrcerned with ir rn impor-trnt
oodifyinq rnd rrby crntrr for
coordinrtinq Srxaoor fiblrr
\(cruxttrv Murcur on th.ir ur.y to
Morz:x:xr' CtREtt^L&ffrl A
'Cru&'Senstioa
rnd hrx nrry be tl
epprrcietcd hrrc I
t
Flgure 12-7 rt
Ho-rizontal brain section. (From McNaught & Callander, lllustrated Physiology'
Used by permis' a
sion ol Churchill Livingstone.) t
a
I
the brain) for incoming sensory stimulation data' an inner medulla composed of white matter' Thl u
cerebellum acts at the subconscious level in cm-
This system is a network of gray matter placed
centrally in the brain stem. dinating reflexes that automatically establish at I
a
upright posture. Thus, p ro p rioc e p t ion (informatim d
on position of limbs and movements of muscles) is a
12-5-2 Cerebellum established through Eeneral and special body pro-
The cerebellura (Figures l2-8 and l2-9) is the sec- prioceptors. Some consider the cerebellum to be r Flgr
part of the "old" brain, involving basic locomotion Vefi
ond largest portion of the brain (the cerebrum is
but not intellectual thought. sim
the largest) and, essentially, integrates incoming
sensory messages to provide smooth body muscle As an example, consider yourself driving a bi-
movements, balance, and equilibriun. This portion cycle or car down a road that has frequent turns'
of the brain has an outer cortex of gray matter and When you begin drifting to the right (l/4 ft)' you