Anatomy.for.Beginners.1of4.Movement.DivX60.AC3.www.mvgroup.org.avi A transcript.

Timings are approximate Bold text is unclear/unverified /bigbreaths August 2005

A 55 year old man, who made an extraordinary wish before he died - that his remains be used by me to educate people about human anatomy. I met him several times. He was passionate about science and about the enlightenment of lay people. Tonight, I will dissect him and unravel the mysteries beneath his skin.

1:27 Lesson one - Movement. Wiggling your toes - it seems an almost inconsequential action, yet the systems that underlie it are amazingly complex. In this series, we will be revealing the systems of the human body so that you can see them for yourselves. And in this programme, we will be beginning with Movement. We will be taking you to the core of the human body, to the central controllers of the brain and the spinal cord. And how they are connected to our movement machines - the muscles. And how the muscles transfer their energy to the system of levers which is our skeleton. But to get there, we firsthave to peel away the part of human anatomy that is most familiar. Dissection has been done since centuries. This picture originates from 1747 and the approach is always the same - at first we have to take off the skin to look at the muscles. And to dissect those, I go over here to our specimen, which is in upright position, because this is the position we move our muscles. For reasons of anonymity, I have covered the face. We want to start from the back, therefore I want to turn around. Marius, could you be

of help, thank you very much. To take the skin away takes a while, therefore we have already started, so we are faster. And I start here. It's a side and I want to take off the skin in one large piece. This is a fresh specimen - we have not fixed it. This way, the muscles are more flexible, it is easier to show you, later on, their function. If you think of the skin as an organ, the skin is actually our largest continuous organ. I think you will be surprised at just quite how big it is when it has actually been fully removed. The skin forms our interface with the external world. It has a number of functions: it conveys sensory information from the outside world to our nervous system; it is responsible for heat regulation - because the sweat glands are located in our skin, The skin also makes specialised structures such as hair and nails, and although it is a continuous organ, it does have specialised areas, for example only our scalp tends to make hair in profusion, only the skin near the tips of our fingers and toes makes nails. Although the skin itself, when it is removed in this way is a very large organ, a lot of the material that you see is actually composed of tough, connective tissue and subcutaneous fat, which also helps to keep us warm. But the actual active portion of the skin is a small growing layer just between the fat and connective tissue and the surface, which is what rubs off when we are in the bath. This layer is only a single cell thick - probably about a 10th of a millimetre thick, and thinner than a piece of tissue paper and as easy to tear or probably easier to tear. But without that growing layer, we wouldn't actually have a skin to protect us.

I want to save the ear and the face. So the skin is loosened and I actually take it now with scissors off the body. Would you help me a little bit?

5:56 The hand, hold it please. The colour of the subcutaneous fat that you see is exactly the same as a Surgeon sees when he is doing an operation. Actually, the skin, the largest organ, depending on the amount of subcutaneous tissue between 3 and 30 kg heavy. You want to put it neatly, you know? This was very important that the specimen looks nice. This now is the skin in its entirety. Here, the skin from the head. The right and left extremity is here the leg. And in fact, although this may seem, and indeed is, a very strange sight - it has a long history in art. One of the most famous examples of the skin being painted in this state can be found on the roof of the Sistine Chapel, where Michelangelo has painted a portrait of himself as the flayed skin of St. Bartholomew. To give you an overview about the muscles - they are all covered by loose, connective tissue - the muscle sheaths, and inside the muscle contracts. Over the trunk, they are the muscles in a flat shape. They move the shoulder blade, they move the rib cage, they move the hips, but, as for the extremities - the muscles always have a rather round shape and they usually end in tendons in dense, connective tissue, like here in the lower arm, or like here in the biceps. Well the logic of dissection means that we must start our study of movement from the outside, with the muscles. So let's first have a look at some muscles in action, and over here we have Juliet, our resident anatomical artist, who is just drawing some muscles on our model Denniss arm here, which we will come to in a moment. But first let me show you a muscle in action, and if I could just ask you to hold that for me, I will swap

it with a ruler, and Dennis here has a particularly fine biceps that we can do a useful demonstration of muscle action on. If you just hold your arm there, and I am just going to extend this ruler so that we can all see roughly, here we are, how long the muscle is, and if I put the end of the ruler near the one there, at the end of Denniss biceps. If you now tense your bicep Dennis, you can see that bulge - it shortened really quite considerably. Just relax again, OK. Let's do that one more time, so there it is and the muscle has actually shortened about half of its length. Thanks. Well, it used to be thought that muscles were some type of spring and that they pinged together when they shortened, perhaps the proteins coiled up. But, in fact, the modern understanding of muscle was only established in about the 1950s when it was found out using electron microscopy - very high magnification microscopy , the muscles really are constructed like little machines. They are made out of interlacing filaments which overlap in this way. And when the muscle is switched on, actually via an arriving nerve impulse, this causes the filaments to interact in such a way that they slide past one another, and when the muscle is switched off, they then relax again. So muscles really are constructed like a small machine, which moves past and back and past and back in shortening and lengthening. Well, if we now have a look at the muscles that Juliet has drawn on Denniss forearm here - we have mentioned the biceps in the top of the arm. Muscles can, of course, only contract. Which means that for every group of muscles, there has to be a group of muscles on the other side of the bone to pull in the other direction. These muscles here, this package of muscles is the group which extends the wrist, it bends the wrist back in this direction. If you just contract those muscles there for us Dennis, you can see the muscle groups here and the tendons running down into Denniss wrist. We are now going to have a look at these groups of muscles in our dissection specimen. 10:14 To show you this on the specimen now we have to turn it around and, okay here are the biceps which we just demonstrated in the live model and here you see the lower arm, and this is a flexion and this is extension and so it is actually the muscles on the lower arm which moves the hands. It is like a puppet show, otherwise there would be too much muscles on the hand. All the small tendons going here, only a few muscles at the

hand itself. So I want to demonstrate this by taking off the flexor muscles of the hand. For that I have to cut off the flexor muscles of the lower arm, which originate here from the medial part of the lower arm, so I just do that.

When I pull here, one moment, give me the knife again. I need to do this also to the periphery, and you will see in a moment that, indeed, the muscles go forward, this takes a moment.

There is actually a large band of connective tissue to avoid, its normally the tendons move out, and I have to open this canal. And then I am able to take the muscles out. All of our muscles and tendons are constructed around our skeleton. Our skeleton is the central strut and force-transmitting tissue of the body, composed of bone. And the area that we are looking at on the dissection specimen at the moment, is the tendons running into the hand and the bulk of the forearm muscle, mass of muscles, here. The tendons themselves actually form a firm join with the bone, which transmits the force from the muscle to the bone, causing movement of the bone at joints.

What I open, here, is a so-called tendinous sheath. It is actually the bed where the tendons move to and fro. That's right, one of the important things about muscles and tendons is that, throughout our lives, they have to be able to move and slide over one another, and not get stuck to either themselves or other structures. So muscles are all contained within their own bags and the tendons also contained within their own sheaths. Sometimes, indeed, you get inflammation of the tendon sheaths called tendonitis. And that can actually cause a painful sensation in the area affected by it.

So as you see, the tendons actually take a quite complicated pathway, here and when I now pull the muscle of the lower arm, the tendons actually are tight and the hand is moving up. And you can imagine how much fine movement must be exerted by the nervous system now. For example, when playing the violin. That's a very striking demonstration of the way we really are constructed according to mechanical principles. There is actually a way you can demonstrate this as well, for yourselves. If you hold your middle finger in the position that I am showing here, you will find that you can't actually move the bottom part of your finger. That's because you have actually lengthened the tendon across this joint here, and the muscle now has no pull, so you find that that will be immobile whereas obviously when you straighten your fingers, the fingers can move again. The extensor muscles of the hand originate out here, mainly from the back of the lower arm. All the tendons are, again, together with the muscles in sheets of very soft, connective tissue, which I would need hours to dissect fully away. But what is important for me to show you is the function. Therefore I go in here and along the ulna The ulna is the bone in the forearm which runs along the side nearest your little finger.

This is a very important nerve, I want not to cut it, so 15:51 It's probably worth pointing out while this is just continuing, that muscles can only contract. So, wherever you find a group of muscles, you will find an opposing group of muscles. If a joint moves one way, it has to have another group of muscles to move it the other way. So the muscles that have just been demonstrated on the palm side of the forearm are called the flexors because they bend the hand forward. And an opposing group of muscle is found on the back side of the forearm called the extensors and they are used to move the hand in the opposite direction.

You can actually now see the mechanical struts of the forearm revealed here - the ulna on this side and the radius on the side nearest the thumb.

In anatomical lectures in this section course for students, this takes about a day to do, but I do here in a few minutes.

So, this is all connective tissue which you have to remove, and one last here then I am ready for the demonstration

So I move not only the finger, but I also move the wrist.

17:46 It's probably worth pointing out that there are also some small muscles, in fact, quite a large number of small muscles within the hand itself, and these are mainly used for the very fine movements. And there are all the connects and bones together to pad, actually, the palm. For that reason, we have on the palm-side more muscles than on the upper side. By now we understand a very important construction feature of the muscles of the extremities. The fingers are moved by muscles of the lower arm. The lower arm is moved by the muscles of the upper arm and the upper arm is moved by the muscles of the shoulder girdle of the scapula and the same holds true, here for the leg. The upper leg is moved by muscles on the buttock and within the abdominal cavity. The lower leg is moved by muscles, here, of the upper leg, primarily by the largest muscle of the human body, which has four heads just in front of the thigh, which is called quadriceps femoris. And I want to show you this muscle by demonstrating, use the fascia - the

connective tissue sheets, where the muscle actually lives in and moves in, and, here very nicely, you can see now I actually can go with a hand inside, between the muscles, between the muscle and this fascia which actually are the supporters and so to expose the muscle in full, I show it all down to this bone, which is the patella, and it serves for moving the power across the joints, the knee joint, to the lower leg. 20:01 One of the unique peculiarities of being human is that we walk on two legs. And this means that whereas the bones in the upper arm can be fairly slender and the muscles can be small and deal with fine movement, the bones in our two legs have to transmit all the force to the ground and the muscles are very large. And we can see the point about weight-bearing on our skeleton over here. If you compare the size, for example, of the humerus in our upper arm with the femur in our upper leg, you can see that the femur is substantially greater than the humerus. And if you could just pass me, we have got over here, thanks. Our bones are often taken to be dead, inert structures because we tend to see them in preserved skeletons like this, but in real life, they have a blood circulation going to them and they are constantly being remodelled to take into account the stresses and strains that are falling on them. And we can see this very clearly in a bone like this - this is a femur that we have been able to bisect. And if I open this femur up here, you can see that it has a really quite striking internal structure. Im just going to put one half down. And you can see that the bones are actually constructed a bit like a box-girder bridge - there is a thick, outside layer called the cortical bone and inside there are numerous fine trabeculae of trabecular bone. And these small, strands of bone serve to transmit the forces from the outer layers of bone, through into the other area, outer layers of bone, and maximise the strength of bone. The point of this is to have the maximum strength for the minimum weight, so we don't carry too many bones around with us. And these little trabeculae are constantly being remodelled throughout life. Another feature we should draw attention to at this point, is our joints, because our joints are necessary for the muscles to be able to move the bones on one another, and I can demonstrate some aspects of joints for you using this pelvis.

First of all, the bones had to be very carefully held together and the structures that do this are ligaments. Ligaments are these very, very tough connective tissue sheaths that extend from one bone to another bone. They are tightly bound to the bone at each side, so that the bones can't come apart. And indeed if you fall awkwardly or pull your bones awkwardly, a rip in one of these ligaments or a strain in one of these ligaments is known as a sprain - a sprain is when you actually damage the ligamented sheath of the bones. In real life, bones are capped by special structure called cartilage. And cartilage forms the interface between one bone and another bone. It is the glistening gristle that you see on bones in meat, but it has a very important structure, it is also constantly remodelled during life. And particularly important for the purpose of especially weight-bearing joints, it is self-lubricating. When one set of cartilage presses on another piece of cartilage, a tiny amount of the fluid inside the cartilage comes onto the surface in a similar way to the way an ice skater is able to skate over the ice on a thin film of fluid, so the cartilage actually glide over one another on a thin film of fluid, and damage to this cartilage is particularly important in a condition for example, osteoarthritis, where the cartilage gets damaged and the bones begin to grind directly onto one another, which is extremely painful and causes distortion of the bone and limitation of joint movement and is, in fact, a very important cause of illness in our society, especially in elderly people. The patella tendon here that is being exposed is one of the biggest tendons in the body and these very large tendons often develop what are called a special type of bone - a sesamoid bone - within them and the kneecap or patella is the biggest such bone in the body, and the idea of this bone is that it is located in the middle of this very big tendon to give added strength. This moment is a real anatomical highlight. We see here on the end of the femur with its cartilage, we have opened the knee joint and here are the crucial ligaments, here are both of the menisci on the outer and the inner side, and here is the patella tendon going to be kneecap and here the large quadriceps muscle. Now, let's take action, I flap it back and when I pull here, then the lower leg should go ahead Again

24:47 The individual parts of human anatomy are surprisingly heavy when they don't have muscular power of their own, so it's actually quite difficult to pull, with your arms, the lower leg, even though our quadriceps muscle in the thigh, manages it with ease. There are so much more muscles, more muscles than I have in both of my biceps. Therefore I have a hard time to move the lower leg in front. While let's just remind ourselves where these muscles are, over on our live model. If I could just turn Dennis round again, here. Juliet has drawn the quadriceps femoris in the front of the thigh here, going down to the patella, which you can demonstrate moving for yourself by flexing and extending your leg. And then another group of muscles has been drawn, here, in the anterior compartment of the lower leg. These are the muscles which flex the foot and the tendons can be seen there, going into the foot. Well, we have seen quite a lot about muscles now, we have figured out roughly how they work, we have seen how they are attached to bones and how the bones move on each other, but what controls all this activity? Well, the central controllers are the brain and spinal cord, and they are buried deep inside our bodies, and that is what we are going to have a look at next. The next what I have to do to turn the body around, because all the muscle actions they are actually commanded by the brain, so we have to expose now, the brain. We have pre-dissected it to a certain extent, and I have to go a little bit up, knife, and I cut through the skull. Now I need the chisel 26:42 Well, it looks a little bit gross, but in the whole world, they do it every day - all anatomists, so... There is no other way, you know? To go inside.. And that is cut, oh, I already see the brain. I am sorry, one moment later you will see it. I go to the other side.. The brain is a difficult organ to expose, because it is hidden away inside a bony case,

the cranium, and the reason for this will become apparent just as soon as we have managed to take the back off the cranium here and expose the brain I need a little bit more of the saw, we didn't pre-saw sufficient {sawing} yes, this should make it

I go through the bone, through the base of the skull

I have to be careful and strong at the same time, because suddenly it may fall down and then what happens with the brain? The brain has a consistency of blancmange and when I touch it, it is elastic and very soft. So what I do now, because we want to show the brain and the spinal cord as one organ, Ill put it back, put it in the same natural condition. And now, I like to show you the consistency of a brain in a simple experiment. We have actually prepared a blancmange and it has, remember, exactly the same consistency. And when I drop it down here, up to 200 million nerve cells will look like that. 29:49 Well, the brain may not look like much from the outside, and it may have a very soft consistency, but internally it is actually a miracle of organisation. The brain is composed of about 10 billion nerve cells and you can see one or two of these on this rather beautiful micrograph here. This is actually prepared by a technique that only shows about one in 50 or one in 100 of the nerve cells present within a given volume of

brain. These little black dots that you can see here, are the nerve-cell bodies, and the little wiggly lines coming off them are the dendrites and axons - the processors of the nerve cells that ramify throughout the nervous system and interconnect with one another. An individual nerve cell may have up to 10,000 different branches, so you can imagine when you have this number of nerve cells interconnected in this way, that the brain has an astonishingly detailed organisation inside. And it is why the brain is so difficult to repair if it gets injured - the fine structure is such that we could hardly hope to intervene. This is a brain which has been preserved by immersing it in a substance called formalin, which firms up its structure. The human brain is a truly remarkable organ - it is no exaggeration to say that it is the most complex object in the known universe. This is the organ through which we see, hear, feel, love, in fact, perform all of the functions that we are aware of, and indeed, many that we are not aware of. Let me show you very briefly, some of the key features of the human brain. It sits in a head like this. The area, here, towards the side is an area which was first identified as having a speech-function, in the brain. The area in the back of the brain, here, is the area that is responsible for processing vision. The area at the front of the brain, here, is involved in our personalities. The cerebellum, the little brain sitting underneath the brain, here, is involved with motor learning and motor coordination. And underneath the brain, you can see the brain-stem running down here, which is responsible for a lot of automatic functions of the body, like breathing, and circulation. Well, let's show you inside the brain in a little bit more detail now, and we can do this by slicing it open. And I want to slice it professionally, and therefore I need assistance and will do it with a machine you may have seen before.

32:33 I will now cut the brain in one centimetre slices in the frontal plane. It is injected. Therefore you see here, inside, white matter and grey matter.

Now, I go to two centimetres of slice. And it actually here you see down the spinal cord, so I order it in consecutive order

The human brain has been studied intensively for over 150 years and there is still so much about it that we don't know. But is probably worth pointing out one or two features on these brain slices. First of all, if you look closely here, you can see that there is a rim running round the outside, the cortex. And a medulla, a white area in the middle. It is in the cortex that most of the nerve cells are found, whereas the fibres running from them are mainly found in the white matter, further in. This band of white matter here, running from one side of the brain to the other is known as the corpus callosum, and it is through this that information travels from one cerebral hemisphere to the other. And finally, this area, here, shows part of the basal ganglia and you can see some white matter and running down through it. This is the tract which takes most of the information directing movement from the cortex down to the spinal cord, and it is in this area that a large number of strokes happen, -that is part of the brain dies when its blood supply is interrupted - which is why strokes are so commonly associated with paralysis. Well, let's follow our movement order now from the motor cortex of the brain, through the internal capsule and down the spinal cord. And to expose, now, the spinal cord, I have to open first, the spinal vertibral column 34:55 And just while this is happening, we can show you over here on a plastinated model, the organisation that you can find at the back of the body. You have already seen the brain, you have seen the brain stem coming down from the brain, and the spinal cord is hidden

away in the protection of the vertebra - running in a canal, right through the middle of the vertebral column - that is what is being exposed now on the dissection specimen. What I do now, I have a flap here. The muscles, the so called erector of the trunk, is quite thick here, I flap it back.

In order I have easy access to the vertibral column, to expose the spinal cord. What I have actually to take away are the spinious processes, and for that, I have to saw from both sides

It's often thought that the spinal cord is just a connecting trunk between the brain and the peripheral nerves, which take the nerve impulses out to the limbs and the rest of the body, but in fact, the spinal cord is part of the central nervous system and an impressive amount of processing of the descending motor impulses that help you move, actually happens within the spinal cord, itself. These are the spinious processes, which we don't need now any more. And they are just covering up here, the spinal cord in its dural sack.

I will now cut the connection between the brain and the spinal cord, here. 37:30 And having seen the degree of structure that there is within both the brain and, by implication, the spinal cord, you can understand why it is so necessary that the spinal cord has to be protected within this bony sheath, because it is a very, very delicate structure with an enormous amount of computing power buried within it.

Well, what I cut off now on both sides, the nerves which, like telephone lines, go to the right and left in with the body along the rib cage, to the arms and down to the leg. And from the vertibral canal now, I remove it the spinal cord in its dural sack. This is connective tissue and what I cut off from both sides are the nerve roots, which go into the whole body to both sides. So I now have already reached here, the lumber region. Go-ahead. Marius would you help? Thankyou. 38:52 The organisation of the spinal cord preserves a memory of when we used to be much simpler creatures - maybe a wormlike creature. And our bodies actually divided into segments, with the nerves coming off paired nerves coming off at each level, supplying those segments. The spinal cord is also organised in segments, which gives information out to the various body segments - both the muscles in those body segments, and the sensory impulses coming back. The spinal cord, although it is protected within the vertibral canal, is clearly is susceptible to injury if the back is injured. And clearly, if a complete transection, that is a complete cut across the spinal cord occurs, then the individual will be paralysed below that level, and will also not be able to feel anything below that level. About at the point we are at now, is the nerves to the leg It may be worth just saying that the actual spinal cord finishes higher up in the vertebral canal than people often think. It actually finishes in the small of the back, and much of the rest of the vertebral canal is occupied by leashes of nerve fibres running down towards the lower limbs which you can very clearly see here, because these are all nerve fibres, you see Thats right, and we are never going to follow the longest of those down to take us back to our wiggling toes.

Cut this, please

40:20 So the end, you see it very clearly, the end of the spinal cord is here and all of these are now nerves, and we follow the largest one through this sciatic nerve at the back of the thigh. Therefore, I have to remove now the gluteal muscle. The spinal cord contains tens of millions of nerve fibres. So, every minute of every day, there are tens of millions of signals passing down your spinal cord to connect with motor neurons which move your muscles, as well as many other tens of millions of sensory impulses, coming back towards the brain. It is an amount of computing power that is actually equalled by nothing else that we know. Well I have to remove here, now part of the sacrum because within the sacrum the plexus runs down.

I continue now to take the spinal cord, or better to say, the nerves at the end of the spinal cord, out The initial little roots that come out of the spinal cord contain either motor movement, fibres - those that come out of the front, or sensory fibres for those that come in at the back, but the peripheral nerves which we are now coming down-to, contain both mixed motor and sensory fibres, which is why a nerve injury usually produces both mixed movement and sensory symptoms. So, what I actually removed is the sacrum in parts of the bone. And I was, too, careful I cut the nerves on the right side.

Here, I expose the rectum, the large intestine from behind.

So, put it all up please, here. And we are now already down here, the sciatic nerve, here, and you go all down, so you see. Within the sciatic nerve, you see the different nerve fibres 43:02 If the central nervous system, that is the brain and spinal cord and are the main central processors, the peripheral nerves are the wires that connect these central processors to the muscles. The peripheral nerves take movement signals down to groups of muscles to induce a particular type of movement, and they also take sensory feedback, which allows us to continuously monitor what we are doing. We follow the nerve down to the toes, cutting off the muscle branches which innovate the muscles of the calf Then take the nerve all out of its bed, all the way down and now we are already down here, at the ankle. So I cut off, now, the nerve that comes to the last muscles of the toe and now I take it all out from the top. I take the spinal cord out of the vertibral canal, take it out here, the spinal plexus, sciatic nerve, peripheral nerve and all down to the toe, and I bring it over here. And I need some assistance now. I don't need this machine any more, could you bring it away, Nadine and Marius.

44:42 Thank you, because the nerve is really very long. down to the toe Well, lets try and give you an idea of the staggering complexity, as well as the real beauty, of our nerve-fibre network.

If I just come over here to our live model and if we could just begin to take the lights down, please. 45:03 So, here we have projected onto Denniss back, a model of both our central and peripheral nervous systems. And so we have finally been able to show you the full journey of a thought which started with wiggling the toes up in the brain, passed down the spinal column, into a leash of nerves passing down the legs and was then able to give the muscles in the front of the leg, the signal to wiggle the toes. A movement which seemed inconsequential, but which I think you will now agree, has an amazing complexity behind it. Now we have time for some questions please.

Once the heart stops to beat, how long does it take before brain cells begin to die? The brain is actually the most sensitive organ in the body to lack of oxygen, and it starts to die within a minute. Next question please Sometimes when we get a pick feeling in our skin we say that it is a nerve ending. Is that really a nerve ending, or is it just some sensation in the skin? If you get a sensation of pins and needles in the skin, it's because a lack of oxygen to the hand, say, because it has been in a funny position, causes the nerve fibres to fire-off and we feel that as a sensation, even though it is only actually originating from the nerve fibres. Next question.

I know you said at the start you did some pre-stuff to get the skin off. If the person had had more fat, would it have been harder for you to get the skin off? When the person would have more fat, I would need much more time about five times as long. One more question? 46:42 When the spinal cord was severed, it reminded me of when Christopher Reeve broke his neck. Now, in doing so, all of the muscles, I mean, he broke his neck, so that just severed everything for him, right? As compared to some people who are paraplegic so have some movement? Very important is the head. When it happens up here, it is quadriplegic and nothing moves any more, perhaps he can open the eyes and close the eyes. When it goes down here, then he cannot move his leg any more is a paraplegic. So it depends very much on the head and only on the cut or the damage at the spinal cord. 47:30 Lets assume our model now decides I want to wiggle my toe. The command starts here in the cortex of the brain, runs down, through the spinal cord, down the sciatic nerve to the toe. And to demonstrate to you this, at our model, I like now, please, assistance to go over to our model. Dennis, thank you very much for presenting yourself. So, what actually happens. We go to the right side here. Because we did at the same side. Denniss brain, spinal cord and could you follow it exactly right to the toe, you see the length is absolutely proper.

And this is the summary of our programme, when Dennis - shown here in the rear specimen, decides to wiggle his toe - it goes from this brain, as you see it in this section, down the spinal cord, down the nerves, into the toe, so he can wiggle it, please.