Received date: October 17, 2018; Accepted date: November 02, 2018; Published date: November 06, 2018.
Neuronal pathways are always disorganized as a dysfunction. Even osteoarthritis the knee locking is disturbed and weight bearing inadequate.
During my long flight from LA to Bombay this thought was disturbing. Future of good rehab depends not only on modalities and general exercise programme but more important is disturbed cartilage pressure due to a lyst. Pain or discomfort leading to atrophy and fibrosis in certain muscles due to incorrect posture and disturbed weight bearing.
Unfortunately millions neural connections in the cortex and the spinal cord cannot be clearly studied by any MRI modality. Phillips company on this subject promised to do more research in this direction. We cannot wait for further time disturbed, the solution is correction clinically. A cassette discussing the aspect of cortical-subcortical reorganization was discussed with A.Bodal MD professor Emeritus and father of neuroanatomy, institute of Anatomy OSLO. He emphasized “The more I have been studying the brain for some 45 years and more struck by the tremendous complexity. Brodal mentioned it is encouraging when a physiotherapist attempt to apply knowledge of anatomy and physiology of the brain in their therapeutic efforts.” This was a great confidence building in my research. With my 60yrs of practice in this field the end result in neuronal pathway readjustment was further very encouraging.
More scientific MRI tractography in the coming future will further confirm our belief in this study of correct neuronal bypass internationally.
Many a newer avenues will open if all contribute and consolidate the rich knowledge of bypass in dysfunction. Figure 1.
Such MRI studies as above gives us clearity of pathways athropied or normal assisting us in bypass theory.
Red colour indicates path left to right Green indicates posterior anterior pathways study Blue inferior superior Not one of us will not, not prevent a fall or an imbalance and therapist will therefore be able to distinquish the causative factor. The result is of bypass and the major pathway is altered final common path.
The lateral vestibular nuclei exerts a strong parallel facilitatory action of ipsilateral motor neuron on right and also the left, thus symmetry for the lyst.
Cerebellum in the spinal path controls and results in inhibitory effect on the lateral vestibular nuclei and hence the possibility of cerebellar bypass clearly indicated by the figure below. This is the collective effect of preserving normal posture. Thus when the patient rotates at the neck and the trunk initiated by the basal ganglia, the result is reduction of vestibular extensor tone and improve function. Cerebellar control coordinated and inhibits the extensor vestibular pathway.
Spasticity is the lesion often involving primary motor cortex, while rigidity is the changes of muscle tone in parkinsonism. Gait in adult is rotation by the basal ganglia, proprioception on heel strike by the cerebellar reaction and good weight bearing by vestibular extensor effect.
BG loss causes lack of rotation thus initiative of lack of proprioception by the cerebellar pathway resulting into inadequate vestibular pathway causing disturbed weight bearing and spinal imbalance. Fear of fall with little provocation of this disturbed relay further causes increase in the repetition of falls, correcting demands is the reversing of the stimulus by increased BG (Rotation) to start. Figure 2.
The two cerebral hemispheres contain more than 300millions neurons. We are touching the tip of the iceberg with DTI (Diffusion Tensor Imaging). Correlation of all these aspects has to be purely clinical. Added to all these is the reticular formation interference alerting effect the sudden noise, light flash and painful stimulus.
No more I feel we would be satisfied with a neurological or an orthopaedic approach alone. It is a total evaluation combining the neuronal controls on the orthopaedic conditions.
Like the cardiac bypass an alternative pathway nonsurgical but will be definitely therapeutic neural bypass. More so we must modify the approach in the conservative orthotics and prosthesis not to forget the disturbed neuronal bypass.