Syllabus
Structure Course no. 12 (Locomotion disorders) of Module IIC "Basic clinical issues" of the reformed curriculum of 3rd Medical Faculty, Charles University (Krbec, Džupa)
Instruction takes place in the summer term, in 6th, 8th and 9th weeks for the Czech speaking students and in 15th week for the English speaking students.
MONDAY
I. Tutorials at the Institute of Anatomy (2 lessons): 1. Introduction - scope of the issue, definition, clinical significance (Krbec, Stingl) 1.1. Reflex (the term, its significance for locomotion and location of disorders) (Mareš) 2. Anatomy and physiology of movement (Stingl) 2.1. Motor unit 2.1.1. CNS (including vision and hearing) 2.1.1.1. Location of central motoneuron disturbances 2.1.2. Spinal cord tracts 2.1.2.1.Localization of afflictions of spinal cord tracts 2.1.3. Peripheral nerve 2.1.3.1. Location of peripheral motoneuron disturbances 2.1.3.2. Conduction by peripheral nerve (Mareš) 2.1.4. Neuromuscular plate 2.1.5. Muscle 2.1.5.1. Muscular contraction (Mareš) 2.1.6. Tendon (synovial sheath) 2.1.7. Tendon - bone insertion (bursa) 2.1.8. Bone 2.1.9. Joint 2.2. Performance of motoric functions 2.2.1. Genesis of voluntary movement 2.2.1.1. Development of motor formula (Mareš) 2.2.2. Extrapyramidal control of movement
II.a Practical training at the Clinic of Neurology (4 lessons): 3. Basic semiology for the differentiation of components of the motor unit (Kellerová) 3.1. Test on strength and range of passive and active motion 3.2. Affection of central motoneuron 3.3. Affection of peripheral motoneuron (including EMG) 3.4. Types of muscular affection (including EMG) 4. Differential neurological diagnosis of locomotion disorders 4.1. Hemipareses of cerebral and spinal origin 4.2. Alternating hemipareses due to affliction of the brain stem 4.3. Monopareses and parapareses 4.4. Peripheral pareses and polyneuropathy 4.5. Myopathy and myositis 4.6. Myasthenia and myotony
II.b Practical at the Institute of Physiology (3 lessons): 5. Lesions of the central regulation of the locomotion - cortical regions, brainstem and spinal structures, with focusing on modulatory circuits - basal ganglia, cerebellum (Mareš) 5.1. Students will actively work with schemes and other study materials, which they will obtain in advance, on the lecture from special pathophysiology 5.2. Students will see the film Parkinson's disease, author E. Růžička and col., Sanofi
TUESDAY
I. + II. Tutorial (2 lessons) and practical training (4 lessons) at the Institute of Pathology: 6. Pathological anatomy of locomotion disorders (Mandys) 6.1. Pathology of bones 6.1.1. Osteochondrodysplasia 6.1.2. Necrosis 6.1.3. Atrophy 6.1.4. Dystrophy 6.1.4.1. Rachitis 6.1.4.2. Osteodystrophia fibrosa 6.1.5. Fractures 6.1.6. Non-specific and specific inflammations 6.1.7. Bone cysts 6.1.8. Hypertrophy and tumours 6.2. Pathology of joints 6.2.1 Dystrophy 6.2.1.1 Ostearthritis 6.2.1.2 Arthritis uratica (gout) 6.2.2 Trauma 6.2.3 Spinal deformities 6.2.4 Arthritis 6.2.5 Tumours 6.3 Pathology of tendons, fascia, synovial sheaths, bursae 6.3.1 Dystrophy 6.3.2 Inflammations 6.3.3 Tumours
WEDNESDAY
I. Tutorial at the Clinic of Radiology (2 lessons): 7. Imaging in locomotion disorders (Šprindrich) 7.1. CNS 7.1.1. X-ray, angiography 7.1.2. CT- myeolography 7.1.3. MRI 7.2. Spinal cord tracts and spinal roots 7.2.1. X-ray, angiography 7.2.2. CT 7.2.3. MRI 7.3.Muscle 7.3.1. Sonography 7.3.2. CT 7.3.3. MRI 7.4.Tendon 7.4.1. Sonography 7.4.2. MRI 7.5. Tendon - bone insertion 7.5.1. Sonography 7.5.2. X-ray 7.5.3. MRI 7.6.Bone 7.6.1. X-ray, angiography 7.6.2. CT 7.6.3. MRI 7.7. Joint 7.7.1. Sonography 7.7.2. X-ray, arthrography 7.7.3. CT 7.7.4. MRI
II.a Practical training at the Clinic of Neurology (4 lessons) + II.b practical at the Institute of Physiology (3 lessons).
For details see the MONDAY schedule.
THURSDAY
I. Tutorial at the Dean´s Office (2 lessons - Institute of Pharmacology): 8. Treatment of locomotion disorders 8.1. Conservative treatment 8.1.1. Pharmacotherapy - analgesics, anti-inflammatory drugs, myorelaxants (Kršiak)
II. Tutorial at the Dean´s Office (1 lesson - Clinic of Rehabilitation Medicine): 8.1.2. Physiotherapy, balneotherapy and rehabilitation (Herbenová)
III.Tutorial at the Dean´s Office (2 lessons - Institute of Medical Ethics): 8.1.3. Ethical issues (Janečková) 8.1.3.1. Quality of life of the disabled 8.1.3.2. Integration of the disabled into the society 8.1.3.3. ???
IV. Tutorial at the Dean´s Office (1 lessons - Clinic of Neurosurgery): 8.2. Surgical treatment 8.2.1. Neurosurgical treatment (Haninec)
FRIDAY
Ia. Tutorial at the Institute of Physiology (3 lessons - Orthopaedic Clinic): 8.2.2. Orthopaedic surgical treatment (Skála, Bartoška)
Ib. Practical at the Institute of Physiology (2 lessons - Institute of Physiology): 9. Ontogenesis of the motor system (Mareš) 9.1. Ontogenesis of the human motor system (tutorial) 9.1.1. Theories of motor development (neuromaturational and systems theory) 9.1.2. Early developmental stages (new-born, suckling, toddler) 9.1.3. Changes of motor system in ageing 9.2. Ontogenesis of the rat motor system (practical) 9.2.1. Motor system of the rats pups before walking 9.2.2. Motor system of the freely mowing rats pups
Ic. Tutorial at the Institute of Physiology (1 lesson - Institute of Biochemistry and Pathological Biochemistry): 10. Pathological biochemistry (Čechák, Kopřivová) 10.1. Extracellular matrix 10.2. Pathologiocal markers
II.a Tutorial at the Institute of Physiology (3 lessons - Orthopaedic Clinic) and II.b practical at the Institute of Physiology (3 lessons - Institute of Pathological Physiology).
Syllabus Course no. 12 (Locomotion disorders) of Module IIC "Basic clinical issues" of the reformed curriculum of 3rd Medical Faculty, Charles University (Krbec, Džupa)
Anatomy:
Optic pathway, auditory pathway, vestibular tract, proprioceptive and motor tracts including extrapyramidal ones, involvement of cerebellum and basal ganglia in the preparation and control of locomotion, plexus nervorum, innervation of individual muscle groups. Muscle, tendon, joint, bone.
Physiology:
Reflex - explanation, types, significance for locomotion, reflex from the veiwpoint of diagnosis of locomotion disorders. Conduction by peripheral nerve, muscular contraction, development of motor formula.
Pathophysiology:
Pathophysiology of motion: Regulation of the motor system in according to the descending parallel systems - dorsolateral (pyramidal) pathway, ventromedial (extrapyramidal) pathways and emotional motor pathways.
Regulation of the motor system in according to the levels (series model) - upper an lower motor neurons and their lesions.
Basal ganglia circuits, direct and indirect pathway, their function and disorders.
Cerebellar circuits, disorders of vermis and cerebellar hemispheres.
Upper motor neurons carry motor information down to the final common pathway (tractus corticospinalis, vestibulospinalis, reticulospinalis, and tectospinalis). These neurons connect the motor cortex to the spinal cord, from which point nerve signals continue to the muscles by means of the lower motor neurons.
Lower (alpha) motor neurons innervate extrafusal muscle fibers of skeletal muscle and are directly responsible for initiating their contraction.
Palsy (paresis) is defined as decrease or loss of voluntary, active movement of a body part often accompanied by loss of feeling.
Paralysis (plegia) is defined as complete loss of strength and motion in an affected limb or muscle group.
Spastic paralysis - an upper motor neuron lesion. Symptoms: "spastic" increase in tone in the extensor muscles (lower limbs) or flexor muscles (upper limbs), "clasp-knife" response where initial resistance to movement is followed by relaxation, brisk tendon jerk reflexes, but no muscle wasting, Babinski sign positive, where the big toe is raised rather than curled downwards on stimulation of the sole of the foot
Flaccid (weak) paralysis - damage to ?-motor neurons, active muscle movement is impossible, passive movement is present, muscle tone is reduced, reflexes are depressed (hyporeflexia), Because muscle size and strength are related to the extent of their use, denervated muscles are prone to atrophy. A secondary cause of muscle atrophy is that denervated muscles are no longer supplied with trophic factors from the ?-motor neurons that innervate them. ?- motor neuron lesions also result in abnormal EMG potentials (e.g., fibrillation potentials) and fasciculations, the latter being spontaneous, involuntary muscle contractions.
Rigidity (stiffness or inflexibility) describes an increase in muscle tone, leading to a resistance to movement, that inhibits active and passive movements through out the range of motion, causes: peripheral (arthritis) and central (Parkinson's syndrome, meningitis).
Decerebrate posturing (rigidity) - indicates brain stem (intercollicular) damage. In decerebrate, or extensor, posturing, the arms are extended by the sides, the head is arched back, and the legs are extended. The activating system of the reticular formation overbalances the inhibitory system of the reticular formation.
Dyskinesia refers to an impairment of voluntary movement associated with the basal ganglia lesions.
Hypokinesia is diminished or slow (bradykinesia) movement of body musculature.
Hyperkinesis is a state of overactive restlessness. It is also a condition resulting in uncontrolled muscle movement.
Akinesis is total lack of movement.
Tremor is defined as the involuntary rhythmic movement of a body part, or parts. This occurs through the contraction of opposing muscle groups. Tremor may occur
Annotation
The course 'Locomotion disorders' explains on the basis of morphological, physiological and pathophysiological findings the syndromology of diseases manifested by disorders of motion and locomotion. It provides a framework information about possibilities of non-operative and operative treatment of these patients.