Walking with Difficulty

Walking with Difficulty

1. Anatomy of the spinal cord

   • 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
     • Descending(motor) tracts
       • Pyramidal tracts
         • skilled voluntary movement
       • extrapyramidal tracts
         • involuntary movement
           • Reflexes
             • tone
             • Components of a reflex arc: Stimulus Sensory receptor Sensory (afferent) neuron CNS integration Efferent (motor) neuron Effector (target tissue) Response (movement)
           • balance
           • tone
             • Physiology of muscle tone
               • maintained by static stretch reflex
                 • sensory receptor
                   • msucle spindle
                     • innervated by
                       • afferent
                         • type ll nerve fibers
                       • efferent
                         • gamma motor fibers
       • descending autonomic
   • Anatomy of the skull
   • • Formation of the CSF
       • The cerebrospinal fluid is produced by the choroid plexus of the ventricles, which is a network of capillaries with fenestrated endothelial cells and specialized ependymal cells.

2. SYRINGOMYELIA

   • cystic degeneration of the spinal cord, usually at C8-T1
     • leads to cape like distribution of pain loss and temperatue
       • compression of nerve fibres
       • Muscle wasting and loss of reflexes. Ptosis, miosis, and anhidrosis.
     • CAUSES
       • Tumor
       • Trauma
       • types
         • INVESTIGATIONS
           • MRI
           • Management
             • Asymptomatic syringomyelia with a small syrinx cavity and with no clear etiology is best managed with watchful waiting and imaging examination.
               • The symptomatic or large syringomyelia is managed by treating the associated condition which is the underlying cause of the syrinx.
       • Chiari malformation

3. Motor assessment

   • UMNL and LMNL
   • GAIT
     • abnormal gait
   • Sensory Assessment
     • Dermatomes

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