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    Tabes Dorsalis

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    Eric Christian
    Tabes dorsalis is a slowly progressive degenerative disorder of the dorsal column and dorsal root of the spinal cord caused by untreated syphilis infection from Treponema Pallidum bacteria. It is a form of late-stage neurosyphilis that occurs 10-15 years after initial infection and results in sensory impairment, ataxia, and Charcot's joints. Diagnosis involves VDRL or RPR tests, and treatment is with penicillin antibiotics along with pain management and physical therapy focusing on coordination, strength, balance, and movement retraining.

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    Tabes Dorsalis

    Uploaded by

    Eric Christian
    56 views36 pages
    Tabes dorsalis is a slowly progressive degenerative disorder of the dorsal column and dorsal root of the spinal cord caused by untreated syphilis infection from Treponema Pallidum bacteria. It is a form of late-stage neurosyphilis that occurs 10-15 years after initial infection and results in sensory impairment, ataxia, and Charcot's joints. Diagnosis involves VDRL or RPR tests, and treatment is with penicillin antibiotics along with pain management and physical therapy focusing on coordination, strength, balance, and movement retraining.

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    Tabes dorsalis is a slowly progressive degenerative disorder of the dorsal column and dorsal root of the spinal cord caused by untreated syphilis infection from Treponema Pallidum bacteria. It is a form of late-stage neurosyphilis that occurs 10-15 years after initial infection and results in sensory impairment, ataxia, and Charcot's joints. Diagnosis involves VDRL or RPR tests, and treatment is with penicillin antibiotics along with pain management and physical therapy focusing on coordination, strength, balance, and movement retraining.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    56 views36 pages

    Tabes Dorsalis

    Uploaded by

    Eric Christian
    Tabes dorsalis is a slowly progressive degenerative disorder of the dorsal column and dorsal root of the spinal cord caused by untreated syphilis infection from Treponema Pallidum bacteria. It is a form of late-stage neurosyphilis that occurs 10-15 years after initial infection and results in sensory impairment, ataxia, and Charcot's joints. Diagnosis involves VDRL or RPR tests, and treatment is with penicillin antibiotics along with pain management and physical therapy focusing on coordination, strength, balance, and movement retraining.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 36

    TABES DORSALIS

     It is a slowly progressive degenerative


    disorder of the dorsal column and dorsal
    root of the spinal cord.
     Tabes dorsalis is caused by demyelination
    due to untreated syphilis infection caused
    by Treponema Pallidum .
     Treponema pallidum infection
    left untreated or partially treated can lead
    to late neurosyphilis,which has two
    forms:
    1. General paresis
    TREPONEMA
    2. Tabes dorsalis(locomotor ataxia) PALLIDUM
     Common complication of syphilis in those infected with
    INCIDENCE HIV
     More common in males than in females.
     Sensory information is
    transmitted through the
    dorsal(posterior) column of
    spinal cord and through
    medial lemniscus in the
    ANATOMY brainstem.
     Dorsal column medial
    lemniscus pathway:Conveys
    sensation of
    vibration,proprioception
    and tactile localization.

    DORSAL COLUMN TRACTS


     Syphilis is a STD
     Tabes dorsalis is a parenchymatous
    PATHOLOGY: form of neurosyphilis and typically
    has a latency 0f 15-30 years from
    the time of infection.
    INOCULATION OF AN
    INDIVIDUAL WITH BACTERIA

    PATHOGENESIS REPLICATION OF BACTERIA

    FORMATION OF
    CHANCRE(painless ulceration)
    in genital area
    SECOND STAGE OF DISEASE:
     After 2-6 weeks,wide infilteration throughout
    the body and nervous system.
     10% untreated cases develop tabes dorsalis
    after 10-15 years.
     Anasthesia
     Impairment of vibration and position sense
     Progressive Ataxia
     Inflammation of meninges leads to
    CLINICAL headache,nausea,vomiting and occasionally seizures.
    FEATURES:  Chronic destructive changes in large joints of the
    affected limb in far advanced cases.-Charcot’s joints.
     Bladder incontinence .
     VDRL(Veneral disease research laboratory test)
    DIAGNOSIS:  RPR (Rapid plasma reagin)
     I.V –Penicillin:Antibiotic
     Opiates
    PAIN RELIEF
    MANAGEMENT:  Valproates
     Carbamazepine
    GOALS OF PT MANAGEMENT:
     Improve coordination
     Improve muscle strength:Strength and endurance
    training of various major muscles of upper limb and
    lower limb.
    PHYSIOTHERAPY  Improve muscle endurance(more repetitions,less weight)
    MANAGEMENT  Improve balance-In sitting,standing,walking
     Improve posture
     Retrain normal movement pattern
     Educate the patient about sensory loss and precautions
    to be taken:Wear protective gloves in feet,hands,use
    equipments for self protection.
     Frenkel’s exercise
     Strengthening exercises
     Balance retraining and use of assistive devices
     Dr H. S Frenkel was the medical superintendent
    of the sanatorium in the Switzerland towards
    the end of last century.

    FRENKEL  He aimed at establishing voluntary control of


    EXERCISES movement by the use of any part of the sensory
    mechanism which remained intact, notably sight
    sound and touch to compensate for the loss of
    kinesthetic sensation.
     The process of learning this technique requires:-
    CONCENTRATION
    PRECISION
    REPETITION
    1. The patient is suitably clothed and positioned
    so that he can see the limbs throughout the
    exercise.
    2. A concise explanation and demonstration of
    the exercise is given before movt is
    attempted, to give the patient a clear mental
    picture of it.
    3. The patient must give his full attention to the
    performance of the movt to make the movt
    smooth and accurate.
    4. The speed of the movt is dictated by the
    physiotherapist by means of rhythmic
    counting, movt of her hand or the use of
    suitable music.
    5. The range of movt is dictated by marking the
    spot on which the foot or hand is to be
    placed.
    6. The exercise is to be repeated many times
    until it is perfect and easy. It is then
    discarded and the more difficult one is
    substituted.
    7. As these exercise are very tiring at first,
    frequent rest periods must be allowed. The
    patient retains little or no ability to
    recognize fatigue, but it is usually indicated
    by the deterioration in the quality of movt, or
    by a rise in the pulse rate.
     Progression is made by altering speed, range and
    complexity of exercise.
     Fairly quick movt require less control than slow
    ones.
     Later, alteration in the speed of consecutive
    movts, and interruptions which involve starting
    and stopping to command are introduced.
     Wide range and primitive movts in which large
    joints are used Gradually give way to those
    involving the use of small joints, limited range
    and frequent alteration of direction.
     Finally simple movts are built up into sequences
    to form specific actions which require the use
    and control of a number of joints and more than
    one limb, e.g., walking
     According the degree of disability, reeducation
    exercises start
    Lying with head propped up and with the limbs
    fully supported

    Progress is made to exercises in sitting

    Standing
    1. Half lying: Hip and knee flexion and
    extension of each limb, foot flat on the
    plinth.
    2. Half lying: Hip abduction and adduction with
    leg fully supported throughout on a smooth
    surface of a plinth or a reeducation board.
    3. Half lying: Hip abduction and adduction of
    each limb with foot flat, with knee flexed
    4. Half lying: One leg raising to place the heel on
    a specified mark.
    5. Half lying: Heel of one limb to opposite leg
    (toes ankle shin and patella)
    6. Half lying: Reciprocal movt of both the limbs
    7. Sitting: Knee flexion and extension of each
    limb.
    8. Sitting: One leg stretching, to slide the heel
    to a position indicated by the mark on the
    floor.
    9. Sitting; Alternate leg stretching and lifting
    to place heel or toe on specified mark.
    10. Stride sitting; Change to standing and then
    sit down again. The feet are drawn back and
    the trunk inclined forwards from the hips to
    get the centre of gravity over the base. The
    patient then extends the legs and draws
    himself up with the help of his hands grasping
    the wall bars or other suitable apparatus.
    11. Stride standing:Transference of weight from
    foot to foot
    12. Stride standing:Walking sideways placing feet
    on the marks on the floor.
    13. Standing; Walking placing feet on the marks.
    14. Standing: Turn around
    15. Standing; walking and changing direction to
    avoid obstacles
    Excercises for arm
    16. Sitting; one arm supported on a table or on a
    sling; shoulder flexion or extension to place
    hand on a specified mark
    17. Sitting; one arm stretching to thread it
    through a small loop or ring
    18. sitting; picking up objects and putting them
    down on a specified mark
    Exercise to promote movement and
    rhythm
    1. Sitting; one hip flexion and adduction to cross
    one thigh over the other, the movt is then
    repeated and reversed.
    2. Half lying; one leg abduction to bring knee to
    side of plinth, followed by one knee bending
    to put foot on floor, the movt is then
    reversed and repeated
    3. Sitting; lean forward and take weight on feet
    (as if to stand), then sit down again.
    4. Standing; arm swing forwards and backwards
    with partner, holding two sticks.
    5. Standing or walking; bounce and catch, or
    throw and catch a ball.
    EXERCISES TO
    PROMOTE RYTHM
    THANK YOU

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