Our first test of my second semester in the books. But while it’s fresh in my head, how can I use this information to help treat my patients once I am out of school?
Friday, we were tested on many basics of the nervous system with the main emphasis on three spinal tracts: The Spinothalamic Tract, Posterior Medial – Leminiscus Column, and Corticospinal Tract.
So what is the significance of these tracts and how does it pertain to the physical therapy profession? Coming into the course, I did not know much about neuroscience nor how my knowledge in this class would help my future patients. After this first exam, I now have a better understanding as to how it will directly affect what I am doing in the clinic.
As a physical therapist, it should be expected that I will work patients who have neurological impairments. What will the presented symptoms tell me in regards to how I will treat them? Although I am not well versed yet in interventions, I would like to spend some time reflecting on some of these processes.
Spinothalamic Tract
This is a tract in our body which is responsible for pain and temperature. It is very important; if there is a problem in the spinal cord affecting this area, for example below your neck, (c6/c7) your patient will not be able to feel any pain or temperature from the neck all the way down to the foot! Can you imagine? With the help of different sharp and dull objects, I as the PT can help locate exactly where the deficit is occurring.
This means many things
- Your use of heat, ultrasound, ice, and other modalities could harm the patient without them feeling a thing! Your patient’s skin could literally be burning and they wouldn’t know! Have you ever accidentally banged your leg on a table, OUCH! A patient who has this deficit would not feel the after effects of hitting his/her leg!
- It may be difficult for a patient to accurately depict how they are truly feeling. If you can’t feel fully feel pain, how could you describe it?
- It is your responsibility as a PT to educate your patient about how to navigate through daily activities.
Posterior-Dorsal Column
- If a patient has any impairment in this column, it can affect their proprioception (their sense in space) or their ability to feel/sense pressure or touch.
In extreme cases of proprioception loss, patients could lose complete control over their entire body or a specific limb.
Here is an example of extreme proprioception loss (click me)
A more mild case where a person can’t identify movements with eyes closed (click me)
With a loss of pressure/touch, many measures would need to take place by the PT in order to ensure the safety of the patient.
What is the importance of seeing a patient who has an impairment somewhere in this tract?
This would mean
- Impaired proprioception could mean the patients balance could be affected. Your patient may have trouble navigating through a crowded hallway, stepping over a box, or even going up stairs! The good news is that much can be retaught!
- A patient with loss of pressure or touch might not be able to give you any feedback if you are doing any type of hands on manipulation, mobility exercise, stretching etc. It will be your responsibility as the physical therapist to treat this patient with the correct amount of touch and pressure since you will not be receiving any feedback from them.
- Once again, it is important to educate your patient about navigating everyday activities as they progress throughout their treatments.
Lateral/Anterior Corticospinal
- Any damage to this tract will result in a loss of motor function, muscle tone, or control of movements. Depending on where the lesion is (brain vs. spinal cord) the injury will present differently. The damage could range from having some slight spastic movements or what appears as decreased strength during movement to the unfortunate circumstance of paralyzation.
- In the event of damage to this tract, a physical therapist will be instrumental in helping a patient live a completely functional and safe.
- How will you help your patient move up and down stairs, in and out of bed, to the bathroom, etc?
- Your patient might be confined to a wheelchair; However there have been many success stories where patients learn to walk again!
- If there is a motor loss in one area of the body, can we strengthen other areas to compensate?
It will be interesting to see how our neuroscience class evolves over the next few weeks. I am particularly interested in how to proceed in a treatment once identifying the deficit. I will be sure to follow up toward the end of the semester with an update!
Thank you for reading!
Dave Send me an e-mail
Coach, Runner, & Physical Therapy Student. 