11

Neurological Neurological Assessment for patient Assessment for patient

with Spinal Injurywith Spinal Injury

KO KwokKO KwokSpine teamSpine team

Department of O&TDepartment of O&TPrince of Wales HospitalPrince of Wales Hospital

22nd April, 200722nd April, 200722

33

OjectiveOjective of neurological of neurological assessmentassessment

Normal / with deficitNormal / with deficitComplete or incomplete Complete or incomplete -- prognosisprognosisUpper motor neuron lesion/ lower motor Upper motor neuron lesion/ lower motor neuron lesionneuron lesionDetail documentation for progress Detail documentation for progress monitoringmonitoring

44

Function appears normalFunction appears normal

Palpate each segment Palpate each segment Inspect the skin for focal Inspect the skin for focal kyphosiskyphosisEvaluate focal pain, spasmEvaluate focal pain, spasmNote any apprehensionNote any apprehension

Indicate instabilityIndicate instability

55

Deficit is foundDeficit is found

Complete / incomplete Complete / incomplete 1. Check spinal shock 1. Check spinal shock

by by bulbocavernosusbulbocavernosus reflexreflex2. Check sacral sparing 2. Check sacral sparing

66

77

Detail documentationDetail documentation

ToneToneMotorMotorCoordinationCoordinationReflexReflexSensationSensation

88

ToneTone

FlaccidFlaccidLower motor neuron lesionLower motor neuron lesionAcute lesionAcute lesion

RigidRigidUpper motor neuron lesionUpper motor neuron lesionChronicChronic

99

MotorMotor

0 = total paralysis0 = total paralysis1 = palpable or visible contraction1 = palpable or visible contraction2 = active movement, gravity eliminated2 = active movement, gravity eliminated3 = active movement, against gravity3 = active movement, against gravity4 = active movement, against some resistance4 = active movement, against some resistance5 = active movement, against full resistance5 = active movement, against full resistance

1010

1111 1212

1313 1414

1515 1616

1717 1818

Conclusion Conclusion

Continuous monitoringContinuous monitoringSpecial patternSpecial pattern

Central cord syndromeCentral cord syndromeASIA score for ASIA score for tetra/paraplegic patienttetra/paraplegic patient

1919

ENDEND