Walking with Difficulty

Walking with Difficulty

1. Anatomy of the spinal cord

   • Spinal nerve
   • Tracts of the spinal cord
     • Ascending(sensory) tracts
       • Posterior Column Tract
         • mediates fine touch and conscious proprioception
       • Spinothalamic tracts
         • anterior
           • mediates crude touch and pressure
         • lateral
           • mediates pain and temperature
       • spinocerebellar tracts
         • unconscious proprioception
           • muscle tone and body posture
       • Sensory assessment
         • crude touch (cotton)
         • pin prick
         • vibration and joint position
         • done over the dermatomes
     • Descending(motor) tracts
       • Pyramidal tracts
         • skilled voluntary movement
       • extrapyramidal tracts
         • involuntary movement
           • reflexes
           • tone
           • balance
       • descending autonomic

2. Anatomy of the skull

3. Physiology of muscle tone

   • maintained by static stretch reflex
     • sensory receptor
       • msucle spindle
         • innervated by
           • afferent
             • type ll nerve fibers
           • efferent
             • gamma motor fibers

4. UMNL and LMNL

5. Motor assessment

   • power
   • tone
   • reflexes
   • GAIT
     • 2 phases; stance and swing
     • abnormal gait
       • skeleton
       • muscles
       • nervous system
         • spastic paraparesis
           • scissots gait
         • parkinson's disease
           • shuffling gait
         • cerebellar
           • a drunken gait
         • posterior column
           • clumsy slapping down of the feet
         • prefrontal lobe
           • apraxic gait

6. SYRINGOMYELIA

   • cystic degeneration of the spinal cord
     • C8-T1 usually
       • compression of nerve fibres
         • symptoms AND SIGNS
           • detected on neurological examination
   • CAUSES
     • Tumor
     • Trauma
     • ischemia
     • Chiari malformation
       • types
   • INVESTIGATION
     • MRI
   • MANAGEMENT
     • type of surgery depends on the cause
       • ACM
         • bony decompression +/- shunt/aspiration
       • trauma
         • aspiration
       • hydrocephalus
         • shunt
       • tumor
         • resection of tumor

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