Neurological Physical Therapy

Physical Therapy for Patient with SCI

Complication

Mei-Ying Kuo

School of Physical Therapy

China Medical University
2004
Classification of the Sensory System
Spinal pathway
• Anteriolateral spinothalmic
• Dorsal column-medial lemi
nisca

(O’Sullivan 2001)
Dorsal column-medial leminisca
 Pyramidal Tract
 Clinical Consideration
– The function of the pyramidal tract
 (1)    Involve the modulation of ascending sensory inform
ation and the regulation of spinal reflex
  Activation of these fibers proceduces presynaptic inh
ibition of afferent fibers, including Ib afferent from Golgi T
endon organs, FRAs from cutaneous receptors, and high
threshold afferents from joint receptors.

 (2) Mediate the execution of precise hand movements th

at are charaterized by fine control of independent digit m
ovements.
Cortical spinal tract
 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)
Reticaular spinal tract
 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
 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
 Reticulospinal Tract
 Influence on Motor Neuron

– Nearly two-thirds of the fibers terminating at cervic

al level.

– Medial reticulospinal tract (Pontine reticulospinal Tract)

 probably has an excitatory influence extensor  motor n
eurons of the trunk and proximal extremity muscle.

– Lateral reticular tract (Medullary reticulospinal Tract)

 probably participate autonomic nervous system in the co
ntrol of respiration, sweating, shivering and other automa
tic motor function.
 Rubrospinal Tract
 Pathway
Rubrospinal Tract – Midbrain (a part of the red nucl
eus) fibers cross immediatel
y  the medulla  dorsolater
al funiculus  locate at anterio
r to the lateral corticospinal tra
ct.
 Rubrospinal Tract
Pathway Control Function

Anteromedial gray Axial muscle Balance,

Proximal muscle Righting Reaction,
Posture

Dorsolateral gray Distal muscle of Various fine

the limb manipulative task,
ex: grasp,
reaching
 Vestibulospinal Tract
 Structure:
Vestibulospinal Tract
– Lateral Vestibuospinal
Tract (LVST)
– Medial Vestibulospinal
Tract (MVST)
– Terminate in Laminae
VII, VIII, IX (trunk musc
le)
 Pathway
 Vestibulospinal Tract
 Influence on motor neurons
– LVST
 Strong excitatory effect on anti-gravity muscle

(extensors)
 extensor motor neurons of the ankle, trunk and

neck are monosynaptically or disaptically facilit

ation.

– MVST
 MVST neurons primarily supply disynaptic inhib

ition to flexor
 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
Peripheral Nerve Fibers: Anatomy
Peripheral nerve

(Barr, 1988)
C2 枕骨粗隆
C3
C4
C5
C6
C7
C8
C2 枕骨粗隆 T1 肘前窩內側 L1 between T12 and L
2
C3 鎖骨上凹窩 T2 腋下
L2 大腿前側中間
C4 acromial T3 第三肋間
L3 medial epicondyle
C5 肘前窩外側 T4 第四肋間
L4 medial malliolus
C6 thumb T5 第五肋間
L5 3th MP
C7 middle finger T6 第六肋間
S1 lateral heel
C8 little finger T7 第七肋間
S2 膕窩中間
T8 第八肋間
S3 坐骨粗隆
T9 第九肋間
S4 肛門口
T10 第十肋間 肚
臍
T11 第 11 肋間
T12 腹骨溝韌帶
中點
 LONG DESCENDING TRACTS AND
MOTOR CONTROL
– Pytramidal Tracts (Cor
ticopinal Tracts)
– Reticulospinal Tracts
– Rubrospinal Tracts
– Vestibulospinal Tracts
 Pyramidal tract (Corticop
inal Tracts)
 85- 90% cross the medline at the caud
al end of the medulla to the lateral corti
cospinal tract.
 55% terminate in cervical (upper e
xtrenmity)
 20% terminate in thorasis (trunk)
 25% terminate in lumbo- sacral (lo
wer limb)
 15% ipsilateral connection:

is called anterior corticopinal tract