Understanding CNS Pathways: Structure, Function, and Clinical Implications

Learning Objective

• At the end of online CPD course, the learner will be able to analyze complex central nervous system pathways to distinguish between normal and pathological sensory and motor Responses.
• At the end of this live online physiotherapy course, the learner will be able to apply neuroanatomical knowledge to diagnose clinical conditions related to sensory and motor dysfunctions, such as proprioception loss and paralysis.
• At the end of this CPD  course, the learner will be able to evaluate the efficacy of therapeutic interventions by appraising sensory-motor integration and its role in maintaining balance and coordinated movement
   

Introduction to CNS Pathways (10 minutes)

Quick overview of the central nervous system (CNS) anatomy

Importance of sensory and motor pathways in body function

Objective of the session: Understanding key sensory and motor pathways

Part 1: Ascending (Sensory) Pathways ( 25 min)

Dorsal Column-Medial Lemniscal Pathway

1. Function: Transmits fine touch, proprioception, and vibration sensation
2. Anatomical course: From sensory receptors to the somatosensory cortex
3. Key clinical conditions: Lesions leading to loss of fine touch and proprioception
4. Case example: Patient with loss of proprioception after spinal cord injury

Spinothalamic Pathway

1. Function: Transmission of pain, temperature, and crude touch
2. Anatomical course: Lateral and anterior spinothalamic tracts
3. Key clinical conditions: Phantom limb pain, temperature sensitivity disorders
4. Case example: Burn patient with altered pain perception

Part 2: Descending (Motor) Pathways (25 min)

Corticospinal Tract (Pyramidal Tract)

1. Function: Controls voluntary movement, especially of the limbs and digits
2. Anatomical course: Motor cortex to the spinal cord (decussation at medulla)
3. Key clinical conditions: Paralysis in upper motor neuron lesions (e.g., stroke)
4. Case example: Hemiplegia following a cerebrovascular accident

Extrapyramidal Pathways

1. Function: Regulates involuntary movements, posture, and muscle tone
2. Pathways: Rubrospinal and vestibulospinal tracts
3. Clinical conditions: Movement disorders like Parkinson’s disease and dystonia
4. Case example: Tremors in Parkinson’s disease

Part 3: Sensory-Motor Integration (20 min)

1. How sensory input informs motor output
2. Reflex arcs: Quick, involuntary responses to sensory stimuli
3. Interaction between sensory and motor pathways in maintaining balance, posture, and coordinated movement

Summary and QnA : (10 min)

Author profile:

Dr. Srishti Banerjee PT MPT ( Neurology)

Dr. Srishti Banerjee is an accomplished physiotherapist with Master in neurology. Her journey includes a BPT from Gujarat University and an MPT in Neurology. She's held roles as a Consultant Physiotherapist and Lecturer.

Dr. Banerjee is an author, contributing to a book on peripheral nerve lesions and a chapter on aquatic therapy.

She's published original articles in various journals and explored topics like hamstring flexibility and the environmental impact of NSAIDs. Srishti is an online educator, offering MOOC courses on sustainable healthcare and shoulder dysfunction post-stroke.

She shares her insights through blogs on neuroplasticity and preoperative physiotherapy. As an author, she's explored sleep disturbance in spinal cord injury patients and the impact of COVID-19 on the nervous system.

She's also a one-page owner on Physiopedia. Through webinars, Srishti covers various topics, including mental health in physiotherapy and environmental sustainability. Her commitment to improving patient care and promoting sustainability in healthcare is evident in her work as an Assistant Professor L. J institute of Physiotherapy, LJ University.