PATHOLOGIC DEFINITION

Tabes dorsalis is a degenerative disease which results of demyelination of the nerves in the posterior part of the spinal cord and progress slowly.Seconder pathologic case causes non-treated syphilis infection.

PREVALENCE

Tabes dorsalis is seen most commonly in male than female. Most of the patients are adults ( 30-35 years ) in general. Especially , the HIV infection increases risk of tabes dorsalis.

MORPHOLOGY

• Degeneration in the posterior ( dorsal ) part of the spinal cord.
• Orthopedic pain ( patients who got tabes dorsalis neuropathy feel severe pain during walking and this painful foot is called the Charcot Foot.)
• Weak reflexes. ( Loss of the patellar reflex is the one of the two most important criteria in the physical examination finding)
• Agryll Robertson Pupil ( It refers to the pupil that does not respond to changes in light intensity and has lost its light reflex, although it shows narrowing in adaptation to nearby objects. )
• Locomotor system attacks
• Degenerated , unbalanced proprioceptive
• Syphilis ( it is systemic disease that gets better if treated early. If it is not treated, serious complications may occur in the brain,nerve,eye and internal organs and may even lead to death.In addition , it is a disease that spread with sexually and if it is contaminated to person icreases the risk of AIDS. Another side of the disease is transmission from mother to baby.)

CLINICAL SIGNS

• Weak muscle coordination
• Reduced reflex or loss of reflex
• Paresthesia
• Hypoesthesia
• Progressive degenerations in specific areas
• Chancing in emotional situations
• Dementia
• Urinary incontinance
• Visual disturbances
• Deafness
• Positive Romberg’s test ( As you can see in the below picture , The patient closes his/her eyes , the doctor/physiotherapist applies resistance at different strengths.These strengths are given to patients if they maintenance their balance with closed eyes. With this test , patients’ vestibuler,proprioception and cerebellar functions are controlled.)

MEDICAL TREATMENT

• Antibiotics
• Analgesic applications
• Protective measures in sexual life

PYSICAL THERAPY AND GOALS OF PHYSIOTHERAPIST

• Precautions and educations for sensory loss
• Strengthening muscles
• Strengthening balance exercises
• Improve coordination
• Mobilization exercises
• Special information: Frenkel’s exercises are a guide that we will refer to in desired balance studies.

SOURCES

Muthuukaruppan M. , Tabes Dorsalis and Physiotherapy
Hook EW. Syphilis. In: Goldman L, Schafer AI, eds. 

[i]Goldman-Cecil Medicine[/i]

. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 319.
National Institues of Health , Bethesda , MD 20892
https://en.wikipedia.org/wiki/Tabes_dorsalis