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METHODICAL INSTRUCTIONS FOR INDIVIDUAL WORK OF THE STUDENTS IN PREPARATION FOR PRACTICAL CLASSES Subject NEUROLOGY Topic Pyramidal tract. Corticomuscular tract. The symptoms of central and peripheral paralyses. Pathological reflexes Year IV Faculty Medical 1. Topicality: Motor system abnormalities happen in the damage of nervous system by many different factors and represent great importance for the diagnostics of the nosologic form of a disease. Motor abnormalities represent one of the main reasons of the life activity damages of the sick, loss of working ability, which has a great social importance. Among motor abnormalities, the loss of the accidental moves ability (paralysis, paresis) is the most widely spread and connected with the damage of a corticomuscular tract. The knowledge of the motor abnormalities connected with the damage of a corticomuscular tract is of great importance in diagnostics of nervous diseases. 2. Specific purposes: - to interpret accidental moves realization -to be able to diagnose paralysis (paresis) - to explain the symptoms central and peripheral paralyses ( pareses) -to be able to distinguish between central and peripheral paralyses Basic level of knowledge and skills: № 1. Subject Anatomy Information to learn The CNS structure, the anatomy of the cerebral cortex, the anatomy of the cerebral column, the anatomy of the spinal cord 2. Physiology The principles of the CNS functioning. The physiology of the motor analyzer. Pyramidal system. Corticomuscular tract. 3. Pathophysiology Manifestations of the corticomuscular tract lesions. 4. Histology The peculiarities of the nervous tissues structure. Nervous system development. Nervous system cells: neurons, neuroglia cells. 4. Assignments for individual work during preparation for the classes: The list of basic terms, characteristics, which students must learn during the preparation for the classes: -motor trench, “Penfield man”, Betz cells -internal capsule, genu of internal capsule, limb of internal capsule -corona radiata -central (spastic) paresis (paralysis, plegia) -peripheral (flaccid, atonic) paresis (paralysis) -combined paresis (paralysis) -Vernike-Mann position (gait) - fasciculation, fibrillation -Barret’s test The list of theoretical questions: 1. Accidental moves realization . Pyramidal system. 2. Сorticonuclear and corticospinal tracts. 3. Corticomuscular tract. 4. Central and peripheral motor neurons. 5. Central (spastic) paralysis symptoms . 6. Pathophysiology of muscular hypertonia, hyperrerflexia, pathological reflexes, abdominal reflexes decrease. 7. Peripheral (flaccid) paralysis symptoms. Pathophysiology of atony, areflexia, atrophy. 8. A notion of a combined paralysis. The list of practical skills that are to be mastered at the classes: 1. Examination of the active and passive moves volume. 2. Methodic of the muscular tonus evaluation. 3. Methodic of the muscle strength evaluation (5-rate scale). 4. Examination of muscular trophism. 5. Examination of the tendinous, periosteal, dermal reflexes (stylocarporadial, biceps, triceps, patellar, Achilles, abdominal). 6. Methodic of the activation of pathological reflexes (extensor ones of Babinsky, Oppenheim, Gordon, Shiffer; flexor ones of Rossolimo, Bekhterev, Zhukovsky etc) 7. Conducting of a Barret’s test 8. Methodic of the activation of clonus and defense reflexes. 9. Fasciculation exposure. 5. Students’ self-preparation curriculum: 1. To learn theoretical questions of the topic 3 (see the list of the theoretical questions and information sources). 2. To know the methodic of examination of motor system. 3. To see the tests and situational tasks (the collection of tests and tasks, the “Reflex Motor Sphere” chapter). 6. Materials for self-control Tests and situational tasks (the collection of tests and tasks – module 1, topical module 1, the “Reflex Motor Sphere” chapter) Information Sources Lecture. 1. Shcrobot S.I., Hara I.I. Neurology in lecture (Selected lectures) . Ternopil, TSMU, «Ukrmedknyha», 2008. 319 p. 2. Reinhard Rohkamm. Color Atlas of Neurology © 2004 Thieme. 440 p. 3. Crash course Neurology by Anish Bahra and Katia Cikurel. Copyright 2006, Elsevier, Inc. 244 p. 4. Adams and Victors. Principles of neurology. © 2005 McGraw-Hill . Medical Publishing Division. 5. Mayo Clinic Internal Medicine Review 2006-2007. Chapter 18. Editor-in-Chief Thomas M. Habermann, MD