Walking with Difficulty

Anatomy of the spinal cord
2. Spinal nerve
3. Tracts of the spinal cord
  1. Ascending(sensory) tracts
    1. Posterior Column Tract
      1. mediates fine touch and conscious proprioception
    2. Spinothalamic tracts
      1. anterior
        mediates crude touch and pressure
      2. lateral
        mediates pain and temperature
    3. spinocerebellar tracts
      1. unconscious proprioception
        muscle tone and body posture
    4. Sensory assessment
      1. crude touch (cotton)
      2. pin prick
      3. vibration and joint position
      4. done over the dermatomes
  2. Descending(motor) tracts
    1. Pyramidal tracts
      1. skilled voluntary movement
    2. extrapyramidal tracts
      1. involuntary movement
        reflexes
        tone
        balance
    3. descending autonomic
Anatomy of the skull
Physiology of muscle tone
1. maintained by static stretch reflex
  1. sensory receptor
    1. msucle spindle
      2. innervated by
        afferent
        type ll nerve fibers
        efferent
        gamma motor fibers
UMNL and LMNL
Motor assessment
1. power
2. tone
3. reflexes
4. GAIT
  1. 2 phases; stance and swing
  2. abnormal gait
    1. skeleton
    2. muscles
    3. nervous system
      1. spastic paraparesis
        scissots gait
      2. parkinson's disease
        shuffling gait
      3. cerebellar
        a drunken gait
      4. posterior column
        clumsy slapping down of the feet
      5. prefrontal lobe
        apraxic gait
SYRINGOMYELIA
1. cystic degeneration of the spinal cord
  1. C8-T1 usually
    1. compression of nerve fibres
      1. symptoms AND SIGNS
        detected on neurological examination
2. CAUSES
  1. Tumor
  2. Trauma
  3. ischemia
  4. Chiari malformation
    1. types
3. INVESTIGATION
  1. MRI
4. MANAGEMENT
  1. type of surgery depends on the cause
    1. ACM
      1. bony decompression +/- shunt/aspiration
    2. trauma
      1. aspiration
    3. hydrocephalus
      1. shunt
    4. tumor
      1. resection of tumor

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Walking with Difficulty

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	Created by Salma Moustafa about 6 years ago