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Gait and Mobility Session: Teaching the Neurology and Neuroanatomy of Spinal Cord Injuries
Author(s) -
Vogel Kristine S.,
Palm Michael
Publication year - 2019
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.2019.33.1_supplement.203.3
Subject(s) - physical medicine and rehabilitation , gait , spinal cord , neuroanatomy , neurology , stairs , medicine , lower motor neuron , psychology , weakness , neuroscience , motor neuron , anatomy , civil engineering , engineering
Medical student knowledge of key ascending and descending pathways (dorsal column/medial lemniscal, spinothalamic, lateral corticospinal) is essential to their ability to identify and assess spinal cord injuries (SCI). In addition, evaluation of gait is an important component of the neurological examination. To incorporate these clinical and neuroanatomical concepts into an interactive session, which is part of an integrated nine‐week neuroscience/neurology/psychiatry module, we combined a gait observation and analysis activity, a review of spinal cord anatomy and lesions, and a question and answer interview with the patient. Before the session, students watched a short, high‐resolution video of the patient, who has a Brown‐Sequard syndrome lesion, navigating stairs and level ground, with and without his cane. They were required to submit at least three observations on the patient's gait and mobility, but were not provided with specific prompts, nor given any information about the location or nature of the lesion. Analysis of over 750 student responses from four years of the module is ongoing, and includes tabulation of lesion localization (e.g. right or left side, upper motor neuron vs. lower motor neuron, cerebral cortex vs. cerebellum vs. spinal cord), aspects of mobility (e.g. use of cane, placement of feet on stairs, turning, balance), and gait descriptors (e.g. circumduction, foot drop, wide‐based). For example, in 2015, 83/213 students correctly identified the side with lower extremity weakness/stiffness, 17/213 identified the incorrect side, and the remainder (113/213) did not indicate the side on which weakness was observed. 66/213 students compared the patient's gait with and without his cane, and 62/213 noted the patient's foot placement while ascending or descending stairs. These classifications of student observations, combined with in‐class analysis and discussion of the video guided by neurology faculty, provide insight into the development of medical student observation skills and familiarity with the neurological examination and terminology. Moreover, the question and answer session with the patient (who is a physician) adds depth to the narrative, and encourages empathy for the mobility challenges faced by individuals who have SCI. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .