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School of Physical Therapy China Medical University 2004

Neurological Physical Therapy. Physical Therapy for Patient with SCI Complication. School of Physical Therapy China Medical University 2004. Mei-Ying Kuo. Classification of the Sensory System. Spinal pathway. Anteriolateral spinothalmic Dorsal column-medial leminisca.

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School of Physical Therapy China Medical University 2004

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  1. Neurological Physical Therapy Physical Therapy for Patient with SCI Complication School of Physical Therapy China Medical University 2004 Mei-Ying Kuo

  2. Classification of the Sensory System Spinal pathway • Anteriolateral spinothalmic • Dorsal column-medial leminisca (O’Sullivan 2001)

  3. Dorsal column-medial leminisca

  4. Pyramidal Tract • Clinical Consideration • The function of the pyramidal tract • (1) Involve the modulation of ascending sensory information and the regulation of spinal reflex •  Activation of these fibers proceduces presynaptic inhibition of afferent fibers, including Ib afferent from Golgi Tendon organs, FRAs from cutaneous receptors, and high threshold afferents from joint receptors. • (2) Mediate the execution of precise hand movements that are charaterized by fine control of independent digit movements.

  5. Cortical spinal tract

  6. Reticulospinal Tract • Pathway • Medial reticulospinal Tract (Pontine reticulospinal Tract) ipsilateral  Spinal cord (Laminae VII, VIII) • Lateral reticulospinal Tract (Medullary reticulospinal Tract)  ipsilateral Spinal Cord cross midline (Laminae VII, IX)

  7. Reticaular spinal tract

  8. Reticulospinal Tract • Reticular Formation (RF) • Connection: spinal cord, cerebellum, brain stain, cerebral cortex, basal ganglia,… • The reticular formation (RF) has no single role, but is involved with a broad range of automatic, or unconscious, neural functions

  9. Reticulospinal Tract • Reticular Formation (RF) • Function • Control of the skeletal muscle • Reticulospinal tract • Control of somatic and vesceral sensation • Control of the automatic nervous system • Medullary reticulospinal Tract • Control of the endocrine nervous system • Influence on the biological clocks • Reticular activating system

  10. Reticulospinal Tract • Influence on Motor Neuron • Nearly two-thirds of the fibers terminating at cervical level. • Medial reticulospinal tract (Pontine reticulospinal Tract) • probably has an excitatory influence extensor  motor neurons of the trunk and proximal extremity muscle. • Lateral reticular tract (Medullary reticulospinal Tract) • probably participate autonomic nervous system in the control of respiration, sweating, shivering and other automatic motor function.

  11. Rubrospinal Tract Rubrospinal Tract • Pathway • Midbrain (a part of the red nucleus) fibers cross immediately  the medulla  dorsolateral funiculus  locate at anterior to the lateral corticospinal tract.

  12. Pathway Control Function Anteromedial gray Axial muscle Proximal muscle Balance, Righting Reaction, Posture Dorsolateral gray Distal muscle of the limb Various fine manipulative task, ex: grasp, reaching Rubrospinal Tract

  13. Vestibulospinal Tract Vestibulospinal Tract • Structure: • Lateral Vestibuospinal Tract (LVST) • Medial Vestibulospinal Tract (MVST) • Terminate in Laminae VII, VIII, IX (trunk muscle) • Pathway

  14. Vestibulospinal Tract • Influence on motor neurons • LVST • Strong excitatoryeffect on anti-gravity muscle (extensors) • extensor motor neurons of the ankle, trunk and neck are monosynaptically or disaptically facilitation. • MVST • MVST neurons primarily supply disynaptic inhibition to flexor

  15. Vestibulospinal Tract • Functional consideration • An important role in the regulation of muscle tone, particular as they influence the control of balance. • The influence of LVST to posture

  16. Peripheral Nerve Fibers: Anatomy Peripheral nerve (Barr, 1988)

  17. C2 枕骨粗隆 C3 C4 C5 C6 C7 C8

  18. C2 枕骨粗隆 C3 鎖骨上凹窩 C4 acromial C5 肘前窩外側 C6 thumb C7 middle finger C8 little finger T1肘前窩內側 T2 腋下 T3 第三肋間 T4第四肋間 T5第五肋間 T6第六肋間 T7第七肋間 T8第八肋間 T9第九肋間 T10第十肋間 肚臍 T11第11肋間 T12 腹骨溝韌帶中 點 L1 between T12 and L2 L2 大腿前側中間 L3 medial epicondyle L4 medial malliolus L5 3th MP S1 lateral heel S2 膕窩中間 S3 坐骨粗隆 S4 肛門口

  19. LONG DESCENDING TRACTS AND MOTOR CONTROL • Pytramidal Tracts (Corticopinal Tracts) • Reticulospinal Tracts • Rubrospinal Tracts • Vestibulospinal Tracts

  20. Pyramidal tract (Corticopinal Tracts) • 85- 90% cross the medline at the caudal end of the medulla to the lateral corticospinal tract. • 55% terminate in cervical (upper extrenmity) • 20% terminate in thorasis (trunk) • 25% terminate in lumbo- sacral (lower limb) • 15% ipsilateral connection: is called anterior corticopinal tract

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