This document summarizes tabes dorsalis, a condition caused by untreated syphilis infection that results in demyelination of the dorsal columns of the spinal cord. It affects males more than females and symptoms onset typically in mid-life. Symptoms include weakness, diminished reflexes, pains, impaired sensation, coordination and gait issues. Diagnosis involves CSF and imaging tests. Treatment focuses on antibiotics while physiotherapy aims to improve strength, balance, mobility and coordination through exercises like Frenkel's exercise which focuses on precision and repetition to compensate for lost sensory function.

1. TABES DORSALIS
Muthuukaruppan M.

2. Introduction:
 Slow degeneration (demyelination) of the
sensory neurons in the dorsal columns of SC.
 Tabes dorsalis is caused by demyelination
secondary to an untreated syphilis infection.
 Syphilitic myelopathy is a complication of
untreated syphilis that involves muscle
weakness and abnormal sensations.

3. The disease is more frequent in males
than in females.
Onset is commonly during mid-life.
The incidence of tabes dorsalis is rising, in
part due to co-associated HIV infection.
Epidemiology:

4. Clinical Features:
Weakness
Diminished reflexes
Paresthesias (shooting and burning pains,
pricking sensations)
Hypoesthesias (abnormally diminished
cutaneous, especially tactile)
Progressive degeneration of the joints
Loss of coordination
Personality changes
Urinary incontinence
Dementia

5. Visual impairment
PositiveRomberg's test
Impaired response to light (Argyll
Robertson pupil).
Muscles are hypotonic due to destruction
of the sensory limb of the spindle reflex.
DTR are diminished or absent
"Tabes dorsalgia" related back pain.
"Tabetic gait" is a characteristic high-
stepping gait - Tabetic Ataxia
Deafness

6. Investigations:
CSF (cerebrospinal fluid) examination
CT or MRI of the brain and spinal cord to
rule out other diseases
Serum VDRL or serum RPR

7. Medical Treatment:
Antibiotics
Analgesics for pain
Preventive treatment for those who
come into sexual contact with an
individual with syphilis is important.

8. Problem List:
Impaired sensation
Weakness
Hypotonicity
Impaired coordination
Impaired gait
Impaired balance

9. Goals for Physiotherapy:
1. Educate about sensory loss and educate
on precautions to be taken
2. Strengthening of muscles
3. Improve balance
4. Improve mobility
5. Improve coordination

10. Physiotherapy Management:
1. Strengthening of muscles.
2. Use of assistive aids to improve mobility
3. Balance retraining
4. Frenkel’s Exercise

11. ●Developed by Dr.H.S.Frenkel
●Tabes dorsalis
●Other conditions, all ataxias, PD, MS
etc
●Aimed at establishing the voluntary
control of movement by the use of any
part of sensory mechanism which
remains intact, notably sight, sound,
touch, to compensate for the loss of
kineasthetic sensation
Frenkel Exercise:

12. ●The essentials of Frenkel exercise being:
● Concentration of Attention
● Precision
● Repetition
●The ultimate aim is to establish the control of
movement so that patient is able and confident
in his ability to carry out these activities which
are essential for independence in every day
life.
Frenkel Exercise:

13. 1. The patient is positioned and suitably clothed so that
he can see the limbs throughout.
2. A concise explanation and demonstration of exercise
is given before movement is attempted, to give
patient a clear mental picture of it.
3. The patient must give his full attention to the
performance of exercise to make movement smooth
and accurate.
4. The speed of movement is dictated by
physiotherapist by means of rhythmic counting,
movement of her hand or the use of suitable music.
Frenkel Exercise:

14. 5. The range of movement is indicated by making the
spot on which the foot and hand is to be placed.
6. The exercise is repeated many times until it is
perfect and easy. It is then discarded and a more
difficult one is substituted.
7. All these exercises are very tiring at first, frequent
rest periods must be allowed. The patient retains
little of no ability to recognize fatigue, but it is
usually indicated by a deterioration in the quality
of movement, or by a rise in pulse rate.
Frenkel Exercise:

16. Frenkel Exercise:

17. THANK YOU